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UNC-CH HEALTH SC!
H00111
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Cfte JLititatp
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DiDi0ion of IE)eaU|) affairs
(anitjet0itp of JI3ort!) Carolina
Cl)t$ book toasi pre$enteD
be
Dean I. M. Taylor
Forty-first Biennial Report
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
July 1, 1964-June 30, 1966
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NORTH CAROLINA BOARD OF HEALTF
MEMBERS OF THE STATE BOARD OF HEALTH
Appointed by the Governor
LENOX D. BAKER, M.D., President
Appointed 1956
Term expires 1969
A. P. CLINE, SR., D.D.S.
Appointed 1965
Term expires 1969
BEN W. DAWSEY, D.V.M.
Appointed 1959
Term expires 1967
SAMUEL G. KOONCE, Ph.G.
Appointed 1963
Term expires 1967
J. M. LACKEY
Appointed 1965
Term expires 1969
Elected by the Medical Society of the State of North Carolina
JAMES S. RARER, M.D., Vice-President
1^ Elected 1963
1?; Term expires 1967
i-^^ OSCAR S. GOODWIN, M.D.
Elected 1950
Term expires 1967
JOSEPH S. HIATT, JR., M.D.
Elected 1965
Term expires 1%9
HOWARD PAUL STEIGER, M.D.
Elected 1965
Term expires 1969
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^^
^ EXECUTIVE STAFF AS OF JUNE 30, 1966
JACOB KOOMEN, JR., M.D., M.P.H.,
^^ Secretary and State Health Director
(Term expires June 30, 1967)
W. BURNS JONES, JR., M.D., M.P.H.,
Assistant State Health Director
(Term concurrent with the State Health Director)
;^ J. M. JARRETT, B.S., Director, Sanitary Engineering Division
MARTIN P. HINES, D.V.M., M.P.H., Director, Epidemiology Division
J. W. R. NORTON, M.D., M.P.H., Director, Local Health Division
E. A. PEARSON, JR., D.D.S., M.P.H., Director, Dental Health Division
THEODORE D. SCURLETIS, M.D., Acting Director,
Personal Health Division
LYNN G. MADDRY, M.S.P.H., Ph.D., Director, Laboratory Division
BEN EATON, JR., LLB., Director, Administrative Services
EDWIN S. PRESTON, M.A., LLD., Public Relations Officer and
Editor, THE HEALTH BULLETIN
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NORTH CAROLINA BOARD OF HEALTH 5
LOCAL HEALTH DIRECTORS IN NORTH CAROLINA
Department Health Director Address and Telephone Number
Alamance—Dr. W. L. Norville, Burlington, N. C. 27218—227-7451 (919)
Alleghany-Ashe-Watauga*—Dr. Mary B. H. Michal, P. O. Box 268, Boone, N. C. 28607
267-2711 (704)
Anson—Dr. Phillip H. Creech, P.T., P. O. Box 473, Wadesboro, N. C. 28170—694-2516 (704)
Avery—Newland, N. C, 28657—733-4971 (704)
Beaufort—Dr. W. A. Browne, Washington, N. C. 27889—946-3101/946-3102 (919)
Bertie—Dr. Karl Van Horn, P. O. Box 397, Windsor, N. C. 27983—794-2161 (919)
Bladen—Dr. Caroline Callison, P. O. Box 188, Elizabethtown, N. C. 28337—862-3467 (919)
Brunswick—Dr. J. R. Black, Southport, N. C. 28461—457-2081 (919)
Shallotte, N. C. 754-6611 (919
Buncombe—Dr. H. W. Stevens, P. 0. Box 7607, Courthouse, Asheville, N. C. 28807
252-7611, ext. 242 (704)
Dr. Irma H. Smathers, P. O. Box 7607, Courthouse, Asheville, N. C. 28807
252-7611, ext. 242 (704)
Burke—Dr. G. F. Reeves, P. O. Box 945, Morganton, N. C. 28655—437-5152 (704)
Cabarrus—P. O. Box 1149, Concord, N. C. 28025—782-4121 (704)
Caldwell—Dr. William Happer, P. O. Box 777, Lenoir, N. C. 28645—754-4241 (704)
Carteret—Dr. Luther Fulcher, P.T., Beaufort, N. C. 28516—728-4557
*Catawba-Lincoln-Alexander—Hickory, N. C. 28601—345-3883 (704)
*Cherokee-Clay-Graham—Murphy, N. C. 28906—837-2311 (704)
Cleveland—Dr. Z. P. Mitchell, P. O. Box 138, Shelby, N. C. 28150—487-8561 (704)
Columbus—Dr. J. R. Black, P. 0. Box 786, Whiteville, N. C. 28472—642-4145 (919)
Craven—Dr. W. A. Browne, New Bern, N. C. 28561—637-3121/637-3122 (919)
Cumberland—Dr. M. T. Foster, P. O. Box 470, Fayetteville, N. C. 28302—483-1336 (919)
Currituck—Dr. W. W. Johnston, Currituck, N. C. 27929 —453-2238 (Coinjock) (919)
Dare—Dr. W. W. Johnston, P. O. Box 476, Manteo, N. C. 27954—473-2480 (919)
Davidson—Dr. Dermot Lohr, P. O. Box 522, Lexington, N. C. 27292—246-5952/246-5953 (704)
*Davie-Yadkin—P. O. Box 457, Mocksville, N. C. 27028—634-2012 (704)
Duplin—Dr. John F. Powers, Kenansville, N. C. 28349—296-2666 (919)
Durham—Dr. O. L. Ader, 300 E. Main Street, Durham, N. C. 27701—682-8176 (919)
Edgecombe—Dr. J. S. Chamblee, Tarboro, N. C. 27886—823-2174/823-2175 (919)
Forsyth—Dr. James A. Finger, P. O. Box 2975, 720 N. Ridge Avenue, Winston-Salem, N. C.
27102—723-8811 (919)
Franklin—Dr. J. B. Wheeless, P.T., P. O. Box 300, Louisburg, N. C. 27549—496-3553 (919)
Gaston—Dr. B. M. Drake, P. O. Box 819, Gastonia, N. C. 28053—864-4331 (704)
Granville—Dr. J. U. Weaver, P. O. Box 1002, Oxford, N. C. 27565—693-7618 (919)
Greene—Dr. Joseph L. Campbell Snow Hill, N. C. 28580—747-3578 (919)
Guilford—Dr. E. H. Ellinwood, 300 E. Northwood Street, Greensboro, N. C. 273-9425 (919)
Dr. Sarah T. Morrow, Asst., 300 E. Northwood Street, Greensboro, N. C. 273-9426 (919)
Halifax—Dr. Robert F. Young, Halifax, N. C. 27839—583-2191 (919)
Harnett—Dr. Melvin F. Eyerman, P. O. Box 36, Lillington, N. C. 27564—893-3425 (919)
Dunn, N. C. 892-2424 (919)
Haywood—Dr. Raymond K. Butler, Waynesville, N. C. 28786—456-3542 (704)
Henderson—Dr. J. D. Lutz, P.T.. P. O. Box 150, Hendersonville, N. C. 28739—692-4223 (704)
Hertford-Gates-Dr. Quinton E. Cooke, Winton, N. C. 27986—358-3191 (919)
Hoke—Dr. Harry H. McLean, P.T., P. O. Box 638, Raeford, N. C. 28376—875-3717 (919)
Hyde—Dr. W. W. Johnston, P. O. Box 254, Swan Quarter, N. C. 27885—926-3566 (919)
Iredell—P. O. Box 1268, Statesville, N. C. 28677—873-7271 (704)
*Jackson-Macon-Swain—Sylva, N. C. 28779—586-2913 (704)
Johnston—P. O. Box 711, Smithfield, N. C. 27577—934-4168 (919)
Jones—Dr. John A. Parrott, Trenton, N. C. 28585—448-2701 (919)
Lenoir—Dr. John A. Parrott, 200 Rhodes Avenue, Kinston, N. C. 28501
523-6110/523-6119 (919)
McDowell—Dr. W. F. E. Loftin, Marion, N. C. 28752—695-6471 (704)
Madison—Dr. Margery J. Lord, P.T., Route 5, Box 231, Marshall, N. C. 28753—649-3531 (704)
Martin—Dr. Karl Van Horn, P. O. Box 546, Williamston, N. C. 27892—792-4133/792-4134 (919)
Mecklenburg—Dr. Maurice Kamp, 1200 Blythe Blvd., Charlotte, N. C. 28203—375-8861 (704)
Dr. Eliz. C. Corkey, Asst., 1200 Blythe Blvd., Charlotte, N. C. 28203 (375-8861 (704)
6 FORTY-FIRST BIENNIAL REPORT
Department Health Director Address and Telephone Number
Mitchell-Yancey*—Burnsville, N. C. 28714—682-2127 (704)
Montgomery—Dr. G. H. Armstrong, P.T., P. O. Box 275, Troy, N. C. 27371—576-4251 (919)
Moore—Dr. Alfred Siege, Carthage, N. C. 28327—947-2711 (919)
Nash—Dr. J. S. Chamblee, Nashville, N. C. 27856—459-2158 (919)
New Hanover—Dr. C. B. Davis, P. O. Box 1491, Wilmington, N. C. 28402—762-1863 (919)
Northampton—Dr. W. R. Parker, Jackson, N. C. 27845—534-3071 (919)
Onslow—Dr. Eleanor Williams, P. O. Box 246, Jacksonville, N. C. 28541
347-2154/347-2155 (919)
*Orange-Person-Chatham-Lee-Caswell—Dr. O. David Garvin, Chapel Hill, N. C. 27514
942-4169 (919)
Dr. C. S. Fuller, Asst., Chapel Hill, N. C. 27514—942-4169 (919)
Pamlico—Dr. W. A. Brow^ne, Bayboro, N. C. 28515—745-2506 (919)
*Pasquotank-Perquimans-Camden-Chowan—Dr. Isa Grant, Elizabeth City, N. C. 27909
335-5429
Pender—Dr. N. C. Wolfe, P.T., Burgaw, N. C. 28425—259-2563 (919)
Pitt—Dr. R. E. Fox, P. O. Box 680, Greenville, N. C. 27834—752-4141/752-4142 (919)
Randolph—Dr. H. C. Whims, P. 0. Box 267, Asheboro, N. C. 27203—625-4227 (919)
Richmond—Dr. L. Thomas Morton, Rockingham, N. C. 28379—895-6304 (919)
Robeson—Dr. E. R. Hardin, P. O. Box 1088, Lumberton, N. C. 28358—739-3344 (919)
Rockingham—Dr. C. T. Mangum, P.T., Spray, N. C. 27352—623-6173 (919)
Reidsville, N. C. 27320—349-6533
Rowan—Dr. M. K. Holler, P. O. Box 1487, Salisbury, N. C. 28144—633-0411 (704)
*Rutherford-Polk—Dr. T. F. Hahn, Rutherfordton, N. C. 28139—287-4931 (704)
Sampson—Dr. Caroline Callison, Clinton, N. C. 28328—592-6177 (919)
Scotland—Dr. L. Thomas Morton, P. O. Box 72, Laurinburg, N. C. 28352—276-1411 (919)
Stanly—Dr. George M. Leiby, P. O. Box 707, Albemarle, N. C. 28001—982-4615 (704)
Stokes—Dr. J. S. Taylor, P.T., Danbury, N. C. 27016—593-7611 (919)
Surry—Dr. Robert Caldwell, P. O. Box 1267, Mount Airy, N. C. 27030—786-4163 (919)
Transylvania—Dr. John R. Folger, P.T., P. O. Box 666, Brevard, N. C. 28712—883-4255 (704)
Tyrrell-Washington*—Dr. Claudius McGowan, P.T., Plymouth, N. C. 27962—793-4416 (919)
Union—Dr. C. A. Bolt, P. O. Box 23, Monroe, N. C. 28110—283-6124 (704)
Vance—Dr. J. U. Weaver, P. O. Box 571, Henderson, N. C. 27536—438-4714 (919)
Wake—Dr. M. B. Bethel, P. 0. Box 949, Raleigh, N. C. 27602—833-1655 (919)
Dr. Jane H. Wooten, Asst., P. O. Box 949, Raleigh, N. C. 27602—833-1655 (919)
Warren—Dr. Lloyd H. Harrison, P.T., P. O. Box 157, Warrenton, N. C. 27589—257-3373 (919)
Wayne—Dr. Carl Hammer, P. O. Box 1537, Goldsboro, N. C. 27530—735-4331 (919)
Wilkes—P. O. Box 30, Wllkesboro, N. C. 28697—838-5591 (919)
Wilson—Dr. Joseph Campbell, Wilson, N. C. 27896—237-3141 (919)
CITY DEPARTMENT
Rocky Mount—Dr. J. S. Chamblee, 1616 W. Thomas Street, Rocky Mount, N. C. 27803
442-5181, ext. 270 (919)
REGIONAL OFFICE
Western Regional Office
N. C. State Board of Health
Biltmore Plaza Office Building
Asheville, N. C. 28803
253-8424 (704)
District Headquarters Corrected December 1966
NORTH CAROLINA
JACOB KooMEN MD MPH STATE BOARD OF HEALTH
STATI «E.LT« DI.ICTO. P O BOX2091
.NosicReT..v-T.,AsuR.. RALEIGH. NORTH CAROLINA 27602
/ BURNS JONES. JR.. M.D . MPH.
December 15, 1956
The Honorable Dan K. Moore
Governor of North Carolina
The State Capitol
Raleigh, North Carolina
Dear Governor Moore:
Pursuant to the provisions of Chapter 130, Article II,
Paragraph 12, General Statutes of North Carolina, I herewith
submit to you, and through you to the General Assembly of
North Carolina, the Biennial Report of the North Carolina
State Board of Health for the fiscal years of July 1, 1964
to June 30, 1966.
Respectfully submitted,
Kjacob Koomen, M.D., M.P.H.
State Health Director
JK:dps
MEMBERS OF STATE BOARD
LENOXO BAKER MO, PRESIDENT- DURHAM BENW DAWSEV D V M - GASTON
,
A
Tr".'-jKZ^°°^"2Zool^nV''°''''''
JAMES RARER MD V IC E PRESI DENT - ASH EV 1 LLE OSCARS GOODWIN M D - APEX J M LACKEY - RT ^ "'""'~"'
Tp Il,NE SR D O S - crN?ON JOSEPH S H.ATT JR . M D - SOUTHERN P,NES HOWARD PAUL STE.OER. M O - CHARLOTTE
CONTENTS
State Board of Health Members and Executive Staff 3
Administrative Organization 4
Local Health Directors 5
Letter of Transmittal 7
Report of Secretary-Treasurer and State Health Director
Abridged Minutes of State Board Actions 9
Dec. 3, 1964—page 9 May 5, 1965—page 17
Aug. 26, 1965—page 19 Dec. 2, 1965—page 24
(Special Session—Dec. 2, 1965—page 27)
May 4, 1966—page 28
Conjoint Sessions
May 5, 1965—Address by William L Wilson, M.D 30
May 4, 1966—Address by Jacob Koomen, M.D,, M.P.H 40
State Health Director 47
Division Reports
Administrative Services Division 48
Division of Epidemiology 52
Laboratory Division 67
Local Health Division 70
Charts—pages 81-92
Dental Health Division 93
Personal Health Division 96
Sanitary Engineering Division 98
Report of the Committee on Postmortem
Medicolegal Examinations 105
Public Health Chronology—1964-1966 108
References given for similar reports 1877 through 1964
REPORT of the SECRETARY-TREASURER and
STATE HEALTH DIRECTOR
Abridged report of the activities of the State
Board of Health as recorded in the Minutes
December 3, 1964
A regular meeting of the North Carolina State Board of Health was held
Thursday, December 3, 1964, 1:00 p.m. to 4:00 p.m., in the Board Room of the
Cooper Memorial Health Building, President Lenox D. Baker, M.D., presiding.
The following members were present:
Dr. Lenox D. Baker, President
Dr. John R. Bender, Vice President
Dr. Ben W. Dawsey
Dr. Glenn L. Hooper
Dr. Oscar S. Goodwin
Mr. D. T. Redfearn
Dr. James S. Paper
Dr. John S. Rhodes
Absent:
Mr. Samuel G. Koonce
The meeting was called to order by President Baker, and the invocation
pronounced by Dr. Oscar S. Goodwin.
On motion of Dr. Glenn L. Hooper, seconded by Dr. Ben W. Dawsey, the
minutes of the May 6, 1964, Board meeting were approved as circulated by
the Secretary.
President Baker asked all members to stand in silent tribute while Dr.
J. W. R. Norton, State Health Director, read the following resolution for adop-tion
by the N. C. State Board of Health, in memory of the late Robert D. Hig-gins,
M.D., Director of the Local Health Division, State Board of Health, who
passed away October 9, 1964:
RESOLUTION OF APPRECIATION AND RESPECT
Robert Donald Higgins, M.D., M.P.H.
"WHEREAS, the sudden and untimely death of Dr. Robert Donald Higgins,
Director of the Local Health Division, has brought profound sorrow to his many
friends and associates, and
"WHEREAS, the State Board of Health, wishing to give recognition to his
influence and invaluable service and to express its sense of loss m his passing
and its grateful appreciation of his great spirit and many virtues, does hereby
set forth this formal resolution of respect.
"A native of Ironton, Ohio, Dr. Robert Donald Higgins received his under-graduate
education in the Crabbe School in Ashland, Kentucky, and at the Uni-versity
of Kentucky. He received his medical degree from the University of
Louisville and his Master of Public Health degree from Harvard University.
10 FORTY-FIRST BIENNIAL REPORT
"He served with distinction as Assistant Surgeon in World War I.
"For forty-three years he had been active in public health, serving in several
important administrative capacities in Kentucky, Florida and North Carolina.
His first service was with the State of Kentucky as Director of the Boyd County
Health Unit and later he served as Director of the Volusia County Health Unit
in Florida.
"On February 1, 1957, he joined the staff of the North Carolina State Board
of Health as Assistant Director of the Local Health Division. Since February 1,
1958, he served as Division Director.
"As an able administrator, valued friend, a master organ and piano player,
joyous comrade, he will live in the hearts of those who knew him—especially
those friends in North Carolina, and in the Southern Branch and national
fellowships of the American Public Health Association.
"BE IT THEREFORE RESOLVED, that this expression of respect and appre-ciation
be formally enacted by the State Board of Health, and spread on its
official minutes, and that a copy be forwarded to the family of our departed
friend to convey, even though inadequately, the sincere sympathy of the mem-bers
of the State Board, and
"BE IT FURTHER RESOLVED, that copies be also sent to the Editor, the
North Carolina Medical Journal; the Editor, Journal of the American Medical
Association; the Editor, the Journal of the American Public Health Association;
the Editor, The Bulletin, American Association of Public Health Physicians;
the Editor, Newsletter of the American College of Preventive Medicine; the
Secretary, the Medical Society of the State of North Carolina; the Secretary,
the North Carolina Public Health Association, and to the Director, the Depart-ment
of Archives and History.
"This the third day of December, 1964."
In relation to a request from the Orange-Durham County Medical Society
for the Board's views regarding requirement of tetanus immunization for
initial issuance of a driver's license and subsequent renewals. Dr. Jacob
Koomen, Jr., Assistant State Health Director, presented a discussion of North
Carolina's present tetanus experience. Dr. Goodwin moved, and Dr. Rhodes
seconded, a motion that the Board approve such a requirement. Motion was
passed unanimously. This action is to be reported to the Orange-Durham
County Medical Society so that it may, in turn, report favorable action to the
State Medical Society. If the State Medical Society approves, the Attorney
General's Office will be asked to draw up a bill for presentation to the coming
legislative session.
Mr. Samuel J. Hawkins, Director of the Emergency Health Preparedness pro-gram
gave a summary of the emergency preparedness program, which was
created to coordinate all services that might be needed in times of disaster
and was delegated to the State Board of Health through the Governor's Office.
Most of these activities are in natural disasters, hurricanes, etc. The most
tangible items of civil defense are the 48 to 200 bed emergency hospitals, and
he showed a map of these hospitals. The next major step is to develop some
type of training for use of these hospitals. In regard to the medical self-help
program. North Carolina has not done as well and is actually lagging in the
number of people trained.
Governor Terry Sanford made a brief visit to the meeting of the State
Board, and in welcoming him, Dr. Baker said, "It is a privilege to have you
come to attend the last meeting which we will hold while you are serving as
NORTH CAROLINA BOARD OF HEALTH 11
Governor of the State of North Carolina. I know of no man who has been
Governor of the State of North Carolina who has done a better job. May I say
you are one of the finest governors, and please tell Mrs. Sanford we think she
has been a wonderful First Lady. We recognize that you have an incurable
disease—that of unselfish dedication to service of your fellownnan. We have
no plans for developing a vaccine against this relatively rare disease."
Governor Sanford said: "Dr. Baker, I am certainly glad to have a chance to
come and meet with this Board. I have tried to keep in touch and to be of
assistance every time you and Dr. Norton called and I have enjoyed working
with the staff members in a number of programs. I have not been attending
board meetings because there are some 157 State boards and commissions.
But I have watched with more than passing interest the many things that
have been done.
"As you may know, Dr. Norton and I come from the same sandhill section of
North Carolina. In fact, we both come from along about the place where Drown-ing
Creek turns into Lumber River. I have certainly known him and he has
known my family for many, many years, I suppose since he was a young boy.
And, so again, I have had a special interest in what was going on here and
special appreciation for what was being done.
"I do not like this business of coming to the end of an administration. I
do not like this business of going around and saying that the time has come
to say goodbye. I can't quite figure out what the proper approach is. In any
event, I did not want to get out of office without expressing my appreciation
and thanks.
"I think a lot of progress has been made. It has been made in many things
that deal with the well-being of the people. Almost everything your Board
does relates to people and their position in life and their capabilities. I think
we could have a little better philosophy of the State if we concerned ourselves
with people and did what we could to put them in a little better position to
fulfil! their capabilities.
"So this agency is typical of what all agencies should be concerning them-selves
with and that is how can we better develop the human resources of the
State. With that, I again say that I am very grateful for the association I have
had with all of you."
Dr. Baker recognized Mr. Thomas W. Lambeth, Administrative Assistant, who
accompanied the Governor.
Dr. Martin P. Hines, Director of the Epidemiology Division, discussed the
major changes in the direction of the new tuberculosis control program of the
State Board of Health, including the discontinuance of the mass Xray mobile
survey program as carried on in the past. He stated that mass Xray surveys
would be discontinued after December 31, 1964. On behalf of the Board, Presi-dent
Baker welcomed Dr. Hines as a new division director.
Dr. J. W. R. Norton, State Health Director, reported on the meeting in Chi-cago
of the National Conference on Medical Aspects of Driver Safety and Driver
Licensing sponsored by the American Medical Association and the Public
Health Service. After discussion, the Board instructed the staff to study ways
12 FORTY-FIRST BIENNIAL REPORT
in which legislation may be needed to promote traffic safety and to give full
support to such constructive legislation as may be sponsored by the Depart-ment
of Motor Vehicles or other agencies.
Dr. Edwin S. Preston, Public Relations Officer, gave a brief review of the
legislative proposals made by the State Board of Health to the 1963 General
Assembly. He indicated that all five of the proposals made at that time were
enacted. A recent request from Governor-Elect Dan K. Moore, for legislation
which was being planned for presentation to the 1965 General Assembly was
circulated to division directors at Dr. Norton's request. No definite proposals
for specific health legislation in the forthcoming General Assembly were
thought to be needed at this time.
Dr. Preston also reviewed briefly the centralized plan for legislative informa-tion
and service which was in effect at Dr. Norton's request in the Public Rela-tions
Office during the 1963 Session of the General Assembly. A mimeographed
sheet presenting this plan was circulated and is filed with the minutes as be-ing
the plan to be used during the coming session. This legislative informa-tion
and service will be available to Board members, State staff and local
health directors. The report was received as information.
Dr. Koomen reported on and discussed the advisability of establishing a
much needed regional public health laboratory facility in the western part of
the State in Asheville. North Carolina is now served by the State Laboratory
in Raleigh. It was noted that it takes several days for specimens to reach
Raleigh from, and reports to be returned to, the far western end of the State.
In the discussion, it was noted that one reason for considering the establish-ment
of a regional laboratory was that the erection of a State office building
in Asheville has been proposed. It was pointed out that several other states
have regional public health laboratories. On motion of Dr. Paper, seconded
by Dr. Hooper, Dr. Norton was instructed to study further the feasibility of
establishing this regional laboratory in Asheville and give a report at the next
Board meeting. Motion carried.
President Baker recognized Mr. Ben Eaton, Jr., Director of Administrative
Services, and cordially welcomed him back on the staff of the State Board of
Health. Mr. Eaton had been granted a leave of absence from the State to
accept a position with the Public Administration Service in Afganistan in
1959. He later served in Peru with North Carolina State College, and has re-turned
to the Board after this five-year absence.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, presented a
petition for a proposed extension of the boundary lines of the Royal Oaks
Sanitary District in Cabarrus County. He stated that all documents and trans-actions
had been carefully examined by his office and were, in his opinion, in
order and in compliance with the law, and he recommended that the State
Board of Health authorize this request for extension of the sanitary district.
On motion of Mr. Redfearn, seconded by Dr. Hooper, the RESOLUTION OF THE
NORTH CAROLINA STATE BOARD OF HEALTH EXTENDING THE BOUNDARY
LINES OF THE ROYAL OAKS SANITARY DISTRICT IN CABARRUS COUNTY,
NORTH CAROLINA, was carried.
NORTH CAROLINA BOARD OF HEALTH 13
Mr. Jarrett also presented a request for the extension of the boundary lines
of the Rural Hall Sanitary District. He stated that the documents, as well as
the various transactions relative to this matter, had been examined by his office
and were in order, and he recommended favorable action by the Board to
annex the proposed territory. On motion of Dr. Hooper, seconded by Dr. Good-win,
the RESOLUTION OF THE NORTH CAROLINA STATE BOARD OF HEALTH
EXTENDING THE BOUNDARY LINES OF THE RURAL HALL SANITARY DIS-TRICT
IN FORSYTH COUNTY, NORTH CAROLINA, was passed.
Also, Mr. Jarrett presented a request for the dissolution of the Dare Beaches
Sanitary District in Dare County. He stated that the Dare Beaches Sanitary
District was created in 1948; the Town of Nags Head is now incorporated and
the Sanitary District has, therefore, served its purpose. Therefore, it is re-quested
that the State Board consider favorably the dissolution of the Dare
Beaches Sanitary District as requested in the petition. He stated that all pro-cedures
were in order, and he recommended that the dissolution request
be authorized by the Board. It was moved by Dr. Goodwin, seconded by Dr.
Rhodes, that the RESOLUTION OF THE NORTH CAROLINA STATE BOARD
OF HEALTH DISSOLVING THE DARE BEACHES SANITARY DISTRICT IN DARE
COUNTY, NORTH CAROLINA, be authorized. Motion carried.
Then, Mr. Jarrett presented a suggestion for revision in Form No. 451—In-spection
Form For Restaurants and Foodhandling Establishments. He recom-mended
the deletion of the words, "facilities adequate for each sex and race"
in Item 6 in the Form, and to insert in place of the above "facilities adequate
to meet Labor Department rules." He explained that the Labor rules would
make use of this same terminology in its new regulations and Mr. Jarrett recom-mended
that this change be made in our Form No. 451, On motion of Dr. Daw-sey,
seconded by Dr. Raper, the recommended change was approved.
Mr. Jarrett also reported on a proposed revision of rules and regulations
governing the sanitation of meat markets, abattoirs, frozen food locker plants,
and poultry processing plants. On motion of Dr. Hooper, seconded by Dr. Daw-sey,
the REVISED RULES AND REGULATIONS GOVERNING THE SANITATION
OF MEAT MARKETS, ABATTOIRS, FROZEN FOOD LOCKER PLANTS, AND
POULTRY PROCESSING PLANTS, was approved. These revised rules and regu-lations
to become effective July 1, 1965.
At the conclusion of Mr. Jarrett's presentation of items. Dr. Baker com-mented
on the long and efficient service which Mr. Jarrett has rendered to
public health in North Carolina and to this Board. He commended Mr. Jarrett
for the excellent manner and form in which the Sanitary Engineering recom-mendations
have been presented to the Board throughout Mr. Jarrett's long
years of service. Dr. Hooper moved and Dr. Raper seconded this sentiment, and
by acclamation the Board gave its unanimous approval of this expression of
appreciation and gratitude.
Mr. W. Gordon Poole, Chief of the Nursing Home Section, presented several
items for consideration and approval by the Board relative to appointments of
members to the Nursing Home Advisory Council to the State Board of Health:
14 FORTY-FIRST BIENNIAL REPORT
(1) Miss Ethel Harrison, R.N., Chapel Hill, to succeed Mrs. Nan Cummings.
Miss Harrison is Assistant Director of Nursing Service at N. C. Memorial Hos-pital;
a member of the Committee on Nursing Care of the Chronically III and
Aged, and currently is Co-Chairman of this Committee. On motion of Dr. Raper,
seconded by Dr. Hooper, the recommendation of Miss Harrison's appointment
was approved.
(2) Mr. Lloyd Gilbert's nomination by the N. C. Hospital Association to suc-ceed
Mr. Joseph Barnes was recommended. Mr. Gilbert is Administrator of the
Johnston Memorial Hospital, Smithfield. On motion of Dr. Goodwin, seconded
by Dr. Rhodes, Mr. Lloyd Gilbert was approved as a member of the Nursing
Home Advisory Council of the State Board of Health.
(3) Dr. D. A. McLaurin, Garner, was re-nominated by the Medical Society of
the State of North Carolina to succeed himself. Dr. McLaurin is a member of
the Chronic Disease Committee of the Medical Society. On motion of Dr. Raper,
seconded by Dr. Hooper, Dr. McLaurin's appointment as a member of the Nurs-ing
Home Advisory Council to the State Board of Health, was approved.
The above nominees are for a three-year term to expire in 1967.
Mr. Poole reported to the Board that Mr. Everett C. Carnes, Attorney to the
Nursing Home Advisory Council—term expiring in 1965, had resigned because
of too many conflicts and professional duties. It was moved by Dr. Hooper,
seconded by Dr. Goodwin, that this resignation be accepted and that this posi-tion
remain unfilled for the present. It was so ordered. It was suggested by the
Board that a letter of thanks be written to Mr. Carnes for his services rendered
during his term of service.
At the request of the Nursing Home Advisory Council, Mr. Poole recom-mended
to the Board that a representative of church and fraternal homes be
included on the Council. On motion of Dr. Goodwin, seconded by Dr. Dawsey,
the request to include a representative from church and fraternal homes was
carried.
Also, Mr. Poole reported that it was recommended by the Nursing Home
Council that it be enlarged in membership by including a representative of
Foundations and Endowments. After discussion, it was moved that the Duke
Endowment submit a nominee and then a mail vote be taken of the Board
members so that the one appointed can begin his term immediately. Motion
made by Dr. Goodwin, seconded by Dr. Rhodes, and carried.
Mr. Poole reported that Dr. Ellen Winston who was an ex-officio member of
the Nursing Home Advisory Council had left the State. Therefore, it was rec-ommended
that the "Commissioner of the State Board of Public Welfare" be
substituted as an ex-officio member. It was moved by Dr. Rhodes, seconded by
Dr. Goodwin, that this replacement be accepted, and that a letter of apprecia-tion
of Dr. Winston's services be written to her. Motion carried.
Mr. George M. Stephens, Jr., Governor Terry Sanford's Special Assistant,
reported on a study that was done this summer which Governor Sanford con-siders
to be of great long-range interest to the State. He distributed copies of
NORTH CAROLINA BOARD OF HEALTH 15
this report "Strategy for Development" and three articles. He stated that sev-eral
seminars have been held on human resources, natural resources and eco-nomic
development. He indicated that the study recommended:
(1) That the long-range planning division already authorized in the Depart-ment
of Administration be activated.
(2) That rather than trying to have all of the planning for the State Govern-ment
operations going on in that unit, that every effort be made to encourage
the agencies of State Government to do their own advance planning and think-ing
so that they can work together and with the Governor even more effectively
on programs for the future.
(3) That the State use the most modern systems that are available for the
collection and analysis of information, including computers.
(4) That the State establish a rational program for working with the regional
planning development associations and groups.
Governor Sanford has endorsed these recommendations and has appointed
a committee of leading citizens and State agency heads to help him get them
carried out. This committee is at the point of recommending initial staff, at
least a director who could head the planning division. Money is being arranged
for and also arrangements are being made for transition into the next adminis-tration.
Mr. Stephens stated that the plan has the endorsement of Governor-
Elect Dan K. Moore.
President Baker, on behalf of the Board, commended Dr. Edwin S. Preston,
Public Relations Officer, on the excellent manner in which he has presented
publicity, news coverage, etc., of the State Board of Health, the staff and the
public health program. He referred particularly to the coverage in The Health
Bulletin of the transfer of licensing and enforcement authority from the Atomic
Energy Commission to the State of North Carolina to be administered by the
State Board of Health.
Dr. W. Burns Jones, Director of the Local Health Division, who is on loan
for three months to assist with the North Carolina Fund and Economic Op-portunity
Program, was present and briefly reviewed as information the purpose
and programs which have been developed in these organizations thus far. On
behalf of the Board, Dr. Baker welcomed Dr. Jones as a new Division Director,
Dr. D. Frank Milam, Chief of the Cancer-Heart-Chronic Disease Section, re-ported
briefly on action taken on request of the Bertie County Hospital for
approval under the State Cancer Program. The Hospital's request was denied
due to failure of this hospital to comply with regulations requiring that Xray
equipment and radium for the treatment of cancer be provided. On request of
the hospital superintendent, the matter was referred to the Chronic Disease
Committee of the Medical Society of the State of North Carolina which sets up
regulations for the cancer programs. At the September meeting of this com-mittee,
the action by the State Board was upheld. Dr. Milam's report was ac-cepted
as information and no action was needed.
16 FORTY-FIRST BIENNIAL REPORT
Dr. Hooper called attention to the Christmas decorations of the Board Room
and thanked Mrs. Edwards, Mrs. Tetterton and Mrs. Mouser for this thoughtful
courtesy.
Mr. Redfearn stated that he had been approached by county managers rela-tive
to the possible greater use of administrative assistants in the local health
departments. The matter was discussed but no action taken.
Mr. Redfearn also commented on the continuing need for avoiding undue
work by local health departments in preparation of complicated reports. Copies
of the rules under which our Permanent Records Committee operates to assure
appropriate handling of this problem were distributed to Board Members.
Mr. Ben Eaton, Jr., Director of Administrative Services, spoke briefly con-cerning
the biennial budget requests of the State Board of Health for 1965-
1967, and of the recent Federal allotments for the fiscal year, 1964-1965.
It was pointed out that the Department has not as yet received any informa-tion
as to action taken by the Advisory Budget Commission on the "B" Budget
requests, which are $1,541,818 for 1965-1966 and $1,626,081 for 1966-1967, or
a total of $3,167,899. Aid to counties through the Local Health Division is the
number one priority in this request. It was emphasized that the counties and
Local Health Departments would receive over 84% of the "B" Budget request
if the "B" Budget receives favorable action by the Legislature. Members of the
Board were urged to give their support through contacts with Legislative repre-sentatives
to the Department's budget proposals.
The Board was advised of the Federal Grant Funds recently made available
to the Department for the year 1964-1965. The overall allocation resulted in
an increase of $248,299 over the year 1963-1964. Virtually all of this increase
came from the large increases in the grants of Maternal and Child Health and
Crippled Children, whereas substantial reductions occurred in the grants to
General Health, Heart Disease, Cancer, Chronic Disease and Venereal Disease.
In General Health alone there was a reduction of $150,000 over the preceding
year. Thus, there is a significant shift in Federal grant policy from formula
grants to grants for special projects or programs.
Dr. Glenn Hooper reported on the advisability of changing the present name
of the "Oral Hygiene Division" of the North Carolina State Board of Health. He
stated that Dr. E. A. Pearson, Jr., the Director, had been concerned for some
time about such a change because a large number of citizens in North Caro-lina
do not understand the true meaning of the words "Oral Hygiene". Quite
often the lay person does not associate the words "oral hygiene" with "dental
health." Another confusion about the name has been experienced in com-munications
both by telephone and letter. For these reasons Dr. Pearson had
recommended to the Board for their consideration a change of the name of
this division from the name "Oral Hygiene Division", to "Dental Health Divi-sion".
On motion of Dr. Hooper, seconded by Dr. Paper, the Board unanimously
approved the change of name as requested to "DENTAL HEALTH DIVISION".
Dr. Baker asked for a clarification of the circumstances surrounding new
funds which are available in the field of mental retardation. It was brought to
NORTH CAROLINA BOARD OF HEALTH 17
Dr. Baker's attention that the funds available in this area are a part of the
regular formula funds through Maternal-Child Health and Crippled Children.
Recent Federal legislation has increased these grants with the provision that
at least one-third of the additional money must be spent on children who have
mental retardation as a significant part of their problems.
On motion duly made and seconded, the Board adjourned about 4:00 p.m.
May 5, 1965
The annual meeting of the North Carolina State Board of Health was held
during the annual meeting of the Medical Society of the State of North Caro-lina
in the Charlotte Merchandise Mart, Charlotte, North Carolina, Wednesday,
May 5, 1965, 8:00 a.m. to 9:15 a.m. Dr. Lenox D. Baker, President of the Board,
presided.
Attending: Lenox D. Baker, M.D.
Ben W. Dawsey, D.V.M.
Glenn L Hooper, D.D.S.
Oscar S. Goodwin, M.D.
D. T. Redfearn, B.S.
James S. Raper, M.D.
Samuel G. Koonce, Ph.G.
John S. Rhodes, M.D.
Absent: John R. Bender, M.D.
Also present was Dr. Howard Paul Steiger of Charlotte, newly elected by
the Medical Society of the State of North Carolina to the Board and who will
take his Oath of Office at the next meeting.
In addition to the Board members, staff members present included: Dr.
J. W. R. Norton; Dr. Jacob Koomen, Jr.; Dr. Martin P. Hines; Dr. Edwin S. Pres-ton;
Mr. John Andrews; Mr. Gordon Poole, and Dr. George Leiby of Johnston
County. Mr. John H. Ketner, Co-Director of the North Carolina Ambulance
Service Study, was also present.
Dr. Baker gave the invocation. The minutes of the last meeting were ap-proved
as circulated.
Dr. Jacob Koomen, Jr., Assistant State Health Director, presented the pro-posal
of a branch laboratory in the western part of the State. He said that
currently 17% of the specimens now being processed in the State Laboratory
originated in western North Carolina. He indicated that it would take approxi-mately
$300,000 to provide an adequate building with equipment and staff for
the first year. Thereafter, the yearly cost would not include the capital expendi-tures.
He stated that there were a number of factors which would need to have
further study before it could be determined whether it was both necessary
and feasible to have such a branch laboratory. The type of specimens, whether
or not they deteriorate because of time in shipping, the availability or
strengthening of county and private laboratories were amongst the factors
which Dr. Koomen indicated should be considered before any wise decision
could be made.
18 FORTY-FIRST BIENNIAL REPORT
Dr. Martin P. Mines, Director of the Epidemiology Division, presented the
two-year study which has resulted in proposed legislation (not yet introduced)
concerning ambulance service regulations. Mr. John H. Ketner, Co-Director of
the North Carolina Ambulance Service Study, was present and participated
in the discussion. Dr. Baker raised a number of questions concerning the pro-visions
of the bill which seemed to give the County Commissioners the respon-sibility
for private ambulance business and might result in a confusing lack of
uniformity in services. It was moved by Dr. Hooper, seconded by Mr. Redfearn
and passed, that the State Board of Health supports the principles set forth
in the bill and will continue in cooperation with the morticians in following
through with their efforts to assure the availability and accessibility of ambu-lance
services throughout the State.
Mr. John Andrews of the Sanitary Engineering Division, recommended re-visions
to the Rules and Regulations Governing the Sanitation of Private Hos-pitals,
Nursing Homes, Rest Homes, Sanitariums, Sanatoriums, Educational and
other institutions. On motion of Dr. Dawsey, seconded by Dr. Hooper, these
revisions were approved. {Copies filed in Minute Book)
Mr. Andrews presented two resolutions for the extension of the boundary
lines of the YANCEYVILLE SANITARY DISTRICT, CASWELL COUNTY. He
stated that the annexation of the proposed territory, documents, as well as the
various transactions relative to this extension, had been examined by the
Sanitary Engineering Division and were in order, and he recommended favor-able
action by the Board. On motion of Dr. Hooper, seconded by Dr. Goodwin,
the two resolutions for the extension of boundary lines of the Yanceyville
Sanitary District in Caswell County, North Carolina, were passed. (Copies filed
in Minute Book)
A proposal to allow recreational activities on GRAHAM CITY RESERVOIR
was also presented by Mr. Andrews. On motion of Dr. Rhodes, seconded by Mr.
Redfearn, the resolution authorizing the City of Graham to permit controlled
fishing and other controlled recreational activities on the City's Reservoir, was
approved. (Copy filed in Minute Book)
Dr. Hooper moved that the body endorse the proposals and program of Gov-ernor
Moore with regard to highway safety. Dr. Hooper's motion was seconded
by Dr. Rhodes, and carried.
Dr. Baker introduced Howard Paul Steiger, M.D., Charlotte Dermatologist,
one of the two newly elected members to the State Board of Health. Joseph
Spurgeon Hiatt, Jr., M.D., Internist of Southern Pines, the other newly elected
Board member by the Medical Society of the State of North Carolina, was not
present at the meeting.
The Board expressed its regret in losing Dr. Rhodes and Dr. Bender from
the Board's membership after the next Board meeting, and expressed thanks
to them for their services.
The Board also expressed its deep regret at the passing of Dr. D. Frank
Milam on April 6, 1965, and asked that a resolution of respect and appreciation
be prepared by the staff for presentation at the next Board meeting.
NORTH CAROLINA BOARD OF HEALTH 19
The Board adjourned to the Conjoint meeting where Dr. Wayne Benton for
the IVledical Society, and Dr. Lenox D. Baker, for the State Board, presided.
Dr. William L Wilson presented the Conjoint Report entitled, "Can 'Medi-cine'
Overtake Technological Civilization?"
August 26, 1965
The regular quarterly meeting of the North Carolina State Board of Health
was held Thursday, August 26, 1965. At 11:00 a.m. the Board met for the oath-taking
ceremony of new Board members in the Hall of the House of the Capi-tol
Building. The invocation was given by The Rev. T. Marvin Vick, Jr., D.D.,
of the Edenton Street Methodist Church. Governor Dan K. Moore welcomed
the many friends, including members of the staff of the Board, for the cere-mony.
Chief Justice Emery B. Denny of the Supreme Court of North Carolina,
administered the Oaths of Office to the following for four-year terms on the
Board of Health:
Governor Dan K. Moore's Appointees
Lenox D. Baker, M.D., (G), 1969—Durham (Re-appointed)
A. P. Ciine, Sr., D.D.S., (G), 1969—Canton
J. M. Lackey, (G), 1969—Route 2, Hiddenite
Elected by the Medical Society of the State of North Carolina
Joseph S. Hiatt, Jr., M.D., (S), 1969—Southern Pines
Howard Paul Steiger, M.D., (S), 1969—Charlotte
The benediction was given by The Rev. Vick.
Following the oath-taking ceremony in the Capitol Building, the members of
the Board proceeded to the Cooper Memorial Building for a regular executive
session in the Board Room,
Attending: Dr. Lenox D. Baker; Dr. James S. Raper; Dr. Ben W. Dawsey;
Mr. Samuel G. Koonce; Dr. Oscar S. Goodwin; Dr. A. P. Cline, Sr.; Dr. Joseph S.
Hiatt, Jr.; Mr. J. M. Lackey, and Dr. Howard P. Steiger.
President Baker presided. The meeting was called to order and the invoca-tion
pronounced by Dr. Baker, after which the new members were introduced
and greeted.
On motion duly made and seconded, the Minutes of the Board Meeting
held on May 5, 1965, were approved as circulated by the Secretary.
President Baker announced that it was time for the election of officers and
a new Executive Committee of the Board for two-year terms ending in 1967
consisting of a President, Vice-President, and two additional Board Members.
Dr. Ben W. Dawsey moved, seconded by Dr. A. P. Cline, Sr., that Dr. Lenox
D. Baker be re-elected as President. Motion unanimously passed.
Dr. Oscar S. Goodwin moved that Dr. James S. Raper be nominated to serve
as Vice-President of the Board. Motion seconded by Dr. Dawsey, and carried.
20 FORTY-FIRST BIENNIAL REPORT
It was moved that Dr. Dawsey and Mr. Samuel G. Koonce be nominated to
serve on the Executive Committee of the Board. Motion seconded, and unani-mously
carried.
Dr. Edwin S. Preston, Public Relations Officer, presented a "Resolution of
Appreciation and Respect" for Dr. D. Frank Milam, who passed away April 6,
1965. Dr. Milam was a member of the Board's staff in the Personal Health
Division. Dr. Goodwin moved that the Resolution be adopted by the Board and
made a part of the records of the State Board of Health. Motion seconded by
Dr. Dawsey, and carried. Copy of the Resolution follows:
RESOLUTION OF APPRECIATION AND RESPECT
Dr. Daniel Franklin Milam
1894-1965
"The death of Dr. Daniel Frank Milam on April 6, 1965, ended a career in
public health which covered more than forty years and three continents.
"Dr. Milam was born in Leesburg, Florida, on May 12, 1894. After primary
education in Kentucky and Florida, Dr. Milam attended Stetson and Vanderbilt
Universities.
"It was only after his service as an Ensign in the Navy during World War I
that Dr. Milam entered the field of medicine at the University of Chicago
Medical School, receiving his M.D. degree in 1923. He received the Master of
Public Health degree from Johns Hopkins University. He served his intern-ship
in 1922-'24 and then went with the Rockefeller Foundation.
"Service with the Foundation took Dr. Milam to Poland, Austria, Canada,
Czechoslovakia, Lebanon, the Virgin Islands, the Philippine Islands, and many
parts of the United States. Included in his tenure with the Foundation was
service in North Carolina, assigned as a Consultant to the State Board of
Health. He first came here in 1932 when he was instrumental in locating the
first cases of Rocky Mountain Spotted Fever in this State. With the assistance
of Dr. Joseph C. Knox, now a Wilmington Pediatrician, he organized the Com-municable
Disease Program which later became the Division of Epidemiology.
For six years, Dr. Milam made a study of the nutritional status of the Bynum
(Chatham County) and certain other rural communities in North Carolina. These
studies were conducted through the Research Departments of Duke University
of North Carolina.
"During this twenty-five years of service. Dr. Milam pioneered in studies on
human nutrition and related subjects. Mrs. Milann has many mementos of their
years in foreign service in their home in Chapel Hill.
"After his retirement from the Rockefeller Foundation, he served as Na-tional
Director of the Planned Parenthood Federation for two years (1948-'50).
In 1950, he became Medical Director of the New York Heart Association, a posi-tion
he held until 1959.
"He then returned to North Carolina as Chief of the Heart, Cancer and
Chronic Disease Sections, where he served so ably until his death. During
his administration of these responsibilities, the areas have progressed in an
outstanding way in this State, matching progress in any other state in the
Nation.
"Dr. Milam was author of a score of articles in medical journals over the
years of his service in public health. He was a Fellow of the American Medical
Association, of the American Public Health Association, and of the New York
Academy of Medicine. He was licensed to practice medicine in Illinois, Florida,
New York, and North Carolina.
NORTH CAROLINA BOARD OF HEALTH 21
"Dr. and Mrs. Milam made their home in the Morgan Creek area of Chapel
Hill. Dr. Milam married Mary Louise Wilson in 1924. They have four children—
a daughter, Mrs. R. P. Creed, New York, N. Y.; and three sons, all of them
medical doctors, Dr. John H. Milam, Winchester, Va.; Dr. D. F. Milam, Jr.,
Bellevue, Washington; and Dr. R. W. Milam, McAllen, Texas. Dr. Milam is also
survived by two brothers, George W. and E. B. Milam, both of Jacksonville,
Florida.
"Because few men have had such long services in public health and few
have served in so many areas of public health; because Dr. Milam was a versa-tile
and dedicated public health physician and yet still had time to be a
patient and kind person; because no one could have regarded him as anything
but the fine gentleman he was; and because of the personal affection he gen-erated
and deserved and his devotion as a public health worker, he will be
missed.
"THEREFORE, BE IT RESOLVED, that this expression of respect and appre-ciation
be formally enacted by the State Board of Health and spread upon its
official Minutes, and that a copy be forwarded to the family of our departed
friend to convey, though inadequately, the heartfelt sympathy of the members
of the State Board, and
"BE IT FURTHER RESOLVED, that copies be also sent to the Editor, North
Carolina Medical Journal; the Editor, Journal of the American Medical Associa-tion;
the Editor, Journal of the American Public Health Association; the Secre-tary,
Medical Society of the State of North Carolina; the Secretary, North
Carolina Public Health Association; to the executives of the Rockefeller Foun-dation;
and of the other organizations with which he was associated.
"This twenty-sixth day of August, 1965."
Dr. Jacob Koomen, Jr., Assistant State Health Director, discussed the
present status of the health related aspects of the Appalachian Regional Com-mission.
Under the Act, multi-county health facilities may be built and staffed.
Soon a twenty-four member committee will be appointed, half by Governors
of States involved, to study the health needs of Appalachia to determine fu-ture
course of action in establishing the multi-county health facilities.
Next, Dr. Koomen presented items relating to Title XVIII of the recently
amended Social Security Act—Public Law 89-97. Each Governor is to designate
the State Agency to work with the Social Security Administration in the im-plementation
of Title XVIII. The responsibilities of the State Agency includes,
as pointed out in the Association of State and Territorial Health Officers News-letter,
June 25, 1965:
"1. Certification that providers (hospital, nursing homes, and home health
programs) meet the established standards;
"2. Providing consultation and assistance in establishing utilization review
staff committees in each institution to review both the quality of care
and the length of stay of patients; and
"3. Providing consultation which will assist hospitals, nursing homes, and
home health programs to participate in the program."
It was brought out that the State Board of Health already carries out some
of these functions and that its present role relates closely to others. Data and
information available to the State has been sent to the Governor's Office. Dr.
Norton has also talked with members of the Governor's staff and the Presi-dent
of the Board, Dr. Lenox D. Baker, has been in communication with Gover-nor
Dan K. Moore.
22 FORTY-FIRST BIENNIAL REPORT
Mr. J. M. Jarrett, Director, Sanitary Engineering Division, presented for con-sideration
by the Board rules and regulations relating to the sanitation of
shellfish and Crustacea. The 1965 General Assembly passed an Act clarifying the
authority of the State Board of Health to regulate the sanitation of harvesting,
processing and handling of shellfish and Crustacea. The Bill directed the State
Board of Health to prepare and enforce regulations. The regulations presented
were the same as in effect prior to July 1 under the authority of the Com-mercial
Fisheries Division of the State Department of Conservation and Devel-opment,
the only change being made in the previous regulations were editorial
changes to comply with the amended law. He recommended the adoption of
these regulations by the Board. Dr. Dawsey moved the adoption of the proposed
RULES AND REGULATIONS RELATIVE TO THE SANITATION OF SHELLFISH
AND CRUSTACEA, as amended. Motion seconded by Dr. Goodwin, and carried.
(Copy attached)
Also, Mr. Jarrett presented and discussed minor changes and amendments
to update the RULES AND REGULATIONS PROVIDING FOR THE PROTECTION
OF PUBLIC WATER SUPPLIES. After consideration by the Board, Mr. Koonce
moved adoption of the proposed amendments. Motion seconded by Dr. Cline,
and carried. (Copy attached)
Dr. Theodore D. Scurletis, Chief of the Maternal and Child Health Section,
Personal Health Division, gave an interim report on the Laboratory for the
screening of metabolic diseases. He stated that through the combined efforts
of the Laboratory Division and the Maternal and Child Health Section, a labora-tory
unit was established for the screening of inborn errors of metabolism.
To-date the program has progressed through a development stage during which
the best time to apply this type of screening procedure on the newborn was
established. Screening for all newborns for PKU will begin November 1 and
this is being announced at present. An advisory committee of biochemists
and pediatricians is guiding the development of this program and it is hoped
that this will lead to screening for detection of other metabolic errors as
soon as feasible. The present cost of this test is about thirty cents (.30(;') which
is about one-third the cost of any other test mechanism. The procedure in-volves
use of the autoanalyzer adapter for protein analysis by Dr. Summers
and Dr. Hill of the University of North Carolina.
Mr. Ben Eaton, Jr., Director of Administrative Services, presented a brief
review of Personnel and Budget for the fiscal years 1965-'67.
It was pointed out that the total State Appropriations for 1965-'67 is $9,664,-
728, or an increase of $1,331,271 over the prior biennium.
The combined total of State and Federal funds for the ensuing fiscal year
1965-'66 is $8,426,860, or an overall increase of $737,290. We do not yet have
the figures from some counties and cannot now indicate the Local appropria-tion,
which for fiscal year 1964-'65 was $8,026,994.
The major State increases for the current fiscal year over the prior year
1964-'65 are found in the ten percent general salary increase which amounts to
$168,231; for new personnel in the Laboratory $40,764; and for Hospital Care
NORTH CAROLINA BOARD OF HEALTH 23
(Cancer, Crippled Children, Maternal and Child Health), $128,951. An increase
of $32,424 was appropriated for Payments to Counties for the first year and
$64,848 for the second year.
In respect to personnel, thirteen additional employees were provided, nine
of which are for the Laboratory, three for Food and Lodging Sanitation, and one
for the Water Supply unit of the Sanitary Engineering Division. Within the
Laboratory, a new PKU Unit for the detection of errors of metabolism in infants
has been established which will utilize three of the employees provided for
this Division.
Mr. Eaton spoke of our additional budget requests for the biennium sub-mitted
to the Joint Appropriation Committee which totaled $2,801,701. This is
commonly known as "B" Budget and was primarily for additional employees
in nine programs, none of which was granted by the Legislature with the ex-ception
of $50,000 for Salt Marsh Mosquito Control. Priority Number One was
a request for $1,306,320 for the biennium for assistance to local health de-partments
to provide employment for much needed public health nurses and
sanitarians. This item of the "B" Budget Request after unfavorable action by
the Committee was revived during Legislative hearings, passed the Senate, but
was defeated in the House. Mr. Eaton stated that strong and effective lead-ership
was given to this request by local health directors. Dr. Norton, Dr.
Koomen, staff members, members of the Board, and others, and that a good
foundation was laid for further consideration by the Advisory Budget Commis-sion
and the next General Assembly.
Of particular concern is the tremendous decrease of Federal funds in the
General Health Grant. This amounted to $143,700 during the past two years.
The trend was first toward categorical grants with substantial decreases later
in this area and now a shift to special project grants. As a result, important
flexibility in our budget processes has been impaired and it presents serious
problems for the future in our budgeting procedures.
It was also noted that grants by the Children's Bureau were more than twice
the grants for the seven programs of Public Health Service which was $2,541,160
as against $1,153,174. There was an increase of $229,727 for the current year in
the two programs of the Children's Bureau, which are Crippled Children and
Maternal and Child Health; whereas, in the Public Health Service programs,
there was an overall increase of only $10,800, reflecting also the very large
decrease in the General Health Grant, heretofore indicated.
President Baker announced that it had been recommended by the Nursing
Home Section of the Board of Health that two new members be appointed by
the Board to serve a 3-year term on the Nursing Home Advisory Council. For
these appointments, Mrs. Edith Chance, Fayetteville, representing the North
Carolina Association of Nursing Homes, and Jere Roe, D.D.S., member of the
North Carolina Dental Society, had been considered.
It was moved by Mr. Lackey that Mrs. Edith Chance be appointed to the
Nursing Home Advisory Council by the Board of Health. The motion was sec-onded
by Dr. Dawsey, and carried. Dr. Cline moved that Dr. Jere Roe be ap-pointed
to the Nursing Home Advisory Council by the Board of Health. The
motion was seconded by Dr. Goodwin, and carried.
24 FORTY-FIRST BIENNIAL REPORT
Dr. Norton reported that Dr. John H. Hamilton was in the hospital for a
thorough check-up. It was moved that Secretary Norton write a note from the
Board expressing their best wishes for a speedy and complete recovery.
President Baker discussed informally Medicare which will be placed in a
State Agency designated by Governor Dan K. Moore. Dr. Norton stated that he
had indicated to the Governor that if placed in the Board of Health, we stood
ready and willing and would welcome the responsibility if it is the wish of the
Governor. Dr. Goodwin moved that the Executive Committee of the Board draw
up a statement to the Governor. The motion was seconded by Dr. Steiger, and
carried.
President Baker asked that the Executive Committee meet immediately
for a short conference following adjournment. At this meeting, the following
letter was drawn up, approved, and sent to Governor Moore:
"Dear Governor Moore:
The State Board of Health in regular quarterly session, August 26, 1965,
approved unanimously the following statement, drafted by its Executive Com-mittee,
on Title XVIII, Public Law 89-97 ("Medicare").
The official Board and Staff of the State Board of Health stand willing,
ready, able and, if the Governor wishes, would welcome designation of the
State Board of Health by the Governor as the Agency responsible for activities
in health protection and promotion, assuring quality preventive and treat-ment
services, and economical operation of Title XVIII, Public Law 89-97
("Medicare"), as it affects this State.'
Respectfully submitted,
J. W. R. Norton, M.D.,
State Health Director
There being no further business, it was moved and seconded that the meet-ing
adjourn.
Note: The State Medical Society Executive Committee meeting also on August
26, 1965, at Duke University, voted unanimously to recommend to Gover-nor
Moore that he designate the State Board of Health as the Agency to
carry out the provisions of Title XVIII. On August 31, 1965, Governor
Moore designated the State Board of Health to fulfill the provisions of
Title XVIII.
December 2, 1965
The regular quarterly meeting of the N. C. State Board of Health was held
Thursday, December 2, 1965, 1:00 p.m.-4:00 p.m., in the Board Room of the
Cooper Memorial Health Building, President Lenox D. Baker, M.D., presiding.
The invocation was given by Dr. Oscar S. Goodwin.
All Board members were present:
Dr. Lenox D. Baker Dr. A. P. Cline, Sr.
Dr. James S. Paper Dr. Joseph S. Hiatt, Jr.
Dr. Ben W. Dawsey Mr. J. M. Lackey
Mr. Samuel G. Koonce Dr. Howard P. Steiger
Dr. Oscar S. Goodwin
NORTH CAROLINA BOARD OF HEALTH 25
In addition to the Board members, there were a number of staff directors
and their assistants present, and each introduced himself and gave a brief
outline of his duties and responsibilities.
On motion duly made and seconded, the Minutes of the August 26, 1965
meeting were approved as circulated.
Mr. J. M. Jarrett, Director of the Division of Sanitary Engineering, presented
a proposed request for the Creation of the Maggie Valley Sanitary District in
Haywood County, North Carolina. He stated that all documents and transactions
had been examined and approved, and were found to be in accordance with
the General Statutes of North Carolina; and, therefore, the Sanitary Engineering
Division recommends that the Creation of the Maggie Valley Sanitary District,
Haywood County, be approved. Upon motion of Dr. Raper, seconded by Mr.
Lackey, the request for the CREATION OF THE MAGGIE VALLEY SANITARY
DISTRICT, HAYWOOD COUNTY, was approved.
Mr. Jarrett also discussed a request for the creation of the Cliffside Sani-tary
District. He stated that the Division was of the opinion that a sanitary
district would improve the sanitary conditions in the area and provide an ade-quate
water supply and sewage treatment facilities. All documents and trans-actions
have been thoroughly investigated by the Sanitary Engineering Division,
and found to be satisfactory, and in accordance with the provisions of the
General Statutes of North Carolina as amended by the 1965 General Assembly.
In view of this, he recommended to the Board that the Cliffside Sanitary
District be created as requested. On motion of Dr. Dawsey, seconded by Dr.
Goodwin, the CREATION OF THE CLIFFSIDE SANITARY DISTRICT, RUTHER-FORD
COUNTY, NORTH CAROLINA, was approved.
Then Mr. Jarrett discussed the criteria for marine toilets which were
adopted by the State Board of Health at its regular meeting in Raleigh on
January 9, 1964. These criteria were established at the request of the U. S.
Army Corps of Engineers and applied to John H. Kerr Reservoir and W. Kerr
Scott Reservoir. Mr. Jarrett recommended to the Board that these criteria
be repealed. On motion of Dr. Raper, seconded by Mr. Lackey, the criteria
for marine toilets adopted on January 9, 1964, were repealed.
For the purpose of carrying out the provisions of Chapter 75A-6 of the
General Statutes as amended by the 1965 General Assembly, Mr. Jarrett pre-sented
revised standards for the approval of sewage treatment devices and
holding tanks for marine toilets to be installed in vessels operating on the
inland lake waters of the State. These rules were discussed and on motion
of Dr. Raper, seconded by Dr. Dawsey, the recommended DESIGN STANDARDS
FOR MARINE SEWAGE TREATMENT SERVICES and HOLDING TANKS, were
adopted. (Copy filed with Minutes)
Dr. W. Burns Jones, Director of the Local Health Division, gave a brief
report on Home Health Services, for information.
Dr. James F. Donnelly, Director of the Personal Health Division, gave a re-port
on the present status of the PKU Screening Program. He stated that the
pilot program for PKU screening has been completed and that it appears from
26 FORTY-FIRST BIENNIAL REPORT
the data compiled so far that the method will be highly selective within a
day or two after birth, so that the screening program can be carried out while
the newborns are still in the hospital. The program will be available Statewide
beginning January 1, 1966.
Also, Dr. Donnelly reported that the expansion of Crippled Childrens' pro-gram
which now supports orthopedic disorders, congenital malformation, burns,
speech and hearing problems, rheumatic heart disease, convulsive disorders,
and cystic fibrosis is expanding its services to include support for asthma and
diabetes. This has been made possible by an increase in federal funds for
crippled children's services of approximately half a million dollars.
President Baker explained the recent publicity in the Durham Herald, read
the headlines, and quoted from the newspaper articles. Don Kellum, a reporter
for the Durham Herald held a news conference with Dr. George 0. Moore in
which Dr. Moore was quoted as labeling the medical group as a hard group
for the State Board of Health to work with. President Baker and Dr. Norton
both called Mr. Kellum. The next morning the headlines, again on the front
page were "NORTON AND BAKER ISSUE REBUTTAL . . ." President Baker
then set up a conference with Dr. Moore, Dr. Norton and the reporter in his
office. Dr. Moore retracted everything in the interview and President Baker
gave the reporter some of the background of the State Board of Health, in-cluding
the fact that it is a child of the Medical Society of the State of North
Carolina. The next morning there was a very short statement which President
Baker also looked up the word "discipline" in the dictionary (with reference
to his remarks concerning disciplining the physicians under the Medicare
program) and read several definitions of discipline and stated that the one
most applicable was "body of laws or practices which may be altered to meet
changing conditions, distinguished from nature and divine laws."
President Baker informed the Board that that morning there was a meeting of
the Executive Committee of the Medical Society of the State of North Carolina,
the State Hospital Association and the State Board of Health, and their Execu-tive
Secretaries. They came out with a motion to the effect that "we were re-questing
the Medical Society of the State of North Carolina and the State Hos-pital
Association to work out some guidelines of instructions, recommendations
and disciplinary lines to the members of the medical profession and to
the hospitals and to the members of the Board of Trustees of the hospitals
as to how these along with the State Board of Health could best implement
Medicare in this State, and that after they had reached this conclusion or
recommendation that it would come back to this Board for our consideration of
approval, and with that in mind one of them or both write one letter and sign
it, to the effect that they had recommended to the State Board of Health the
following things with regard to the utilization review committees on who should
be hospitalized and how the reports should come in. We had full cooperation
of the group attending this morning meeting."
Dr. Goodwin moved that the Board approve the action of the group which
met just prior to the Board meeting, and Dr. Cline seconded. Passed.
Dr. Jacob Koomen, Jr., Assistant State Health Director, discussed briefly
the Appalachian Regional Commission's role in health. A twenty-five (25) mem-
NORTH CAROLINA BOARD OF HEALTH 27
ber Health Advisory Committee, Is In the process of establishing guidelines
for Implementation of the health related portions of the Act.
As Information to the Board, Mr. Ben Eaton, Jr., Director of Administrative
Services, reported on the untimely death of Mr. Walter Croy, Assistant Budget
Officer, which occurred on October 19, 1965. Mr. Eaton spoke of the Invaluable
service that Mr. Croy had rendered and referred to him as a very able and
fine gentleman.
Mr. Eaton also reported briefly on the budgetary progress of the new pro-gram
entitled "Home Health Services" which was discussed earlier by Dr. W.
Burns Jones. He stated that the State matching requirements for this new
program Is one dollar ($1.00) for each ten dollars ($10.00) provided by the Fed-eral
Government which is on an exceptionally favorable basis. The State will
be required to provide approximately $20,800 for this new program which, at
this time, we are seeking to arrange within the overall budget of the Depart-ment.
Mr. Eaton suggested to the Board that each member may wish to review
his copy of the proposed Agreement between the Department of Health, Edu-cation,
and Welfare, and the State Board of Health concerning the administra-tion
of the Medicare Program. This proposal which has not been executed,
outlines the major responsibilities of the State Board In dealing with this
program.
As information for the Board, Dr. Norton gave brief verbal reports on the
following items of interest:
(a) Signing of the Medicare Agreement ceremony to be held in the Gover-nor's
Office at 11:15 a.m. Monday, December 6, 1965.
(b) Conference to be held on December 15, 1965, with representatives from
the Social Security personnel regarding Medicare, budget, personnel, etc.
(c) Meeting in Pinehurst for orientation, etc. on Medicare January 27-30,
1966.
On motion duly made and seconded, the Board meeting adjourned.
SPECIAL SESSION
December 2, 1965
In a special session of the Board held on December 2, 1965, North Carolina
State Health Director, Dr. J. W. R. Norton submitted his resignation. He asked
that the resignation, submitted because of health reasons, be made effective
December 31, 1965. As requested by the Board, Dr. Norton agreed to assume a
position In the State Board of Health other than that of State Health Director
or Assistant State Health Director. The Board and the Board of Health ex-pressed
regrets over Dr. Norton's resignation, and appreciation for his services
as Director during the past seventeen and a half years. Dr. Norton's letter
of resignation Is filed with the official Minutes.
After discussion, the Board, subject to the approval of the Governor, took
the following action: (1) Named Dr. Jacob Koomen Acting State Health Director
28 FORTY-FIRST BIENNIAL REPORT
and Secretary-Treasurer for the remainder of Dr. Norton's appointment; (2)
Named Dr. W. Burns Jones, Jr. Acting Assistant State Health Director for the
remainder of Dr. Koomen's appointment.
President Baker, Dr. Cline and Dr. Norton conferred with Governor Dan K.
Moore concerning the above recommendations to the Board. Governor Moore
gave his approval to the action of the Board.
Dr. Koomen v^^as sworn into office at noon Tuesday, January 4, 1966, in the
John H. Hamilton Auditorium of the Laboratory Division of the State Board
of Health. Dr. Lenox D. Baker presided. Governor Dan K. Moore expressed
appreciation for Dr. J. W. R. Norton's long service and confidence in Dr. Koo-men's
leadership for the future. North Carolina Supreme Court Justice Susie
Sharp administered the oath of office.
May 4, 1966
The North Carolina State Board of Health met in conjunction with the an-nual
session of the Medical Society of the State of North Carolina in the
Grove Room, Battery Park Hotel, Asheville, Wednesday, May 4, 1966, 8:00 a.m.
to 8:30 a.m. Dr. Lenox D. Baker, President of the Board, presided.
Attending: Lenox D. Baker, M.D.
James S. Paper, M.D.
Ben W. Dawsey, D.V.M.
Oscar S. Goodwin, M.D.
A. P. Cline, Sr., D.D.S.
Joseph S. Hiatt, Jr., M.D.
J. M. Lackey
Howard P. Steiger, M.D.
Absent: Samuel G. Koonce, Ph.G.
In addition to the Board Members, staff members present included: Dr.
Jacob Koomen; Dr. W. Burns Jones, Jr.; Mr. J. M. Jarrett; Dr. Edwin S. Preston;
Dr. William A. Smith; Mr. W. Gordon Poole; and Mrs. Doris P. Sitterson.
Dr. Baker pronounced the invocation. The Board approved the minutes of
the Board Meeting held December 2, 1965, as circulated.
Dr. Koomen gave a brief report on the activities of the Board of Health
during the past four months. Board Members expressed approval of the new
procedure of receiving periodic letters from Dr. Koomen describing State
Board of Health activities instead of the bulky mimeographed Reports of the
past. Dr. Koomen reported on the preparation of the "A" Budget, which is now
completed; and the "B" Budget which is being compiled. Dr. Koomen stated
that we are hard at work on the implementation of Medicare. North Carolina
is well ahead of most of its neighboring states.
Dr. Koomen reported to the Board his action in appointing Dr. Lynn Maddry
as Director of the Laboratory Division of the State Board. Mrs. Corrina Sutton
will serve as Acting Assistant Director of the Laboratory. Miss Elizabeth S.
Holley, formerly on the staff of the School of Public Health, UNC, has been
NORTH CAROLINA BOARD OF HEALTH 29
named Chief of Public Health Nursing Section. Dr. William A. Robie has ac-cepted
the position as Chief of the Heart, Cancer and Chronic Disease Section,
within the Personal Health Division.
Dr. Koomen expressed his appreciation to the Board for all the help the>
have given him and the other members of the staff.
Mr. Jarrett, Director of the Sanitary Engineering Division, presented, for the
approval of the Board, a request for the extension of the Rural Hall Sanitary
District In Forsyth County, North Carolina. He stated that his office had
examined the documents, including an original petition from the residents, and
that they were in compliance with the statutes as required by law. Mr. Jarrett
therefore recommended approval of the request for this extension of the Rural
Hall Sanitary District. Dr. Raper moved THAT THE STATE BOARD OF HEALTH
APPROVE THE REQUEST FOR THE EXTENSION OF THE BOUNDARIES OF
THE RURAL HALL SANITARY DISTRICT IN FORSYTH COUNTY, NORTH CARO-LINA.
The motion was seconded by Mr. Lackey and passed.
For his second presentation, Mr. Jarrett stated that his office had received
a request for the extension of the Yanceyville Sanitary District. He further
stated that all documents and transactions had been examined and approved,
and were found to be in accordance with the General Statutes of North Caro-lina;
and therefore, the Sanitary Engineering Division recommends approval
of the extension of the Yanceyville Sanitary District. A motion by Dr. Steiger
THAT THE STATE BOARD OF HEALTH APPROVE THE REQUEST FOR THE
EXTENSION OF THE BOUNDARIES OF THE YANCEYVILLE SANITARY DIS-TRICT
IN CASWELL COUNTY, NORTH CAROLINA, was seconded by Dr. Raper
and carried.
Mr. Jarrett brought before the Board for their approval a list of acceptable
marine toilets. For detailed explanation, see materials in official files. Dr.
Goodwin moved THAT THE STATE BOARD OF HEALTH APPROVE THE LIST
OF ACCEPTABLE MARINE TOILETS AS PRESENTED. Dr. Raper seconded the
motion and it was passed.
There being no further business to come before the Board, the meeting
was adjourned.
In a brief Executive Session following the General Board meeting. Dr. Jacob
Koomen was officially elected as State Health Director, Dr. W. Burns Jones
was elected Assistant State Health Director. Both elections were to become
effective upon approval by Governor Dan K. Moore. The Governor's approval was
secured by phone by Dr. Baker on this same date.
30 FORTY-FIRST BIENNIAL REPORT
CONJOINT SESSION
CAN "MEDICINE" OVERCOME TECHNOLOGICAL CIVILIZATION?
May 5, 1965—Address by William L Wilson, M.D.
Chief, Occupational Health Section, North Carolina State Board of Health.
"Not only in antiquity, but in our own times also laws have
been passed in well-ordered cities to secure good conditions for
the workers; so it is only right that the art of medicine should con-tribute
its portion for the benefit and relief of those for whom the
law has shown such foresight; indeed we ought to show peculiar
zeal, though so far we have neglected to do so, in taking precau-tions
for their safety, so that as far as possible they may work at
their chosen calling without loss of health".—Ramazzini
Two and a half centuries ago Ramazzini, the father of occupational health,
challenged "medicine" thus. Our neglect persists. Hence, it is appropriate
at this time to devote attention to this subject. A State Board of Health occu-pational
health study of some circumstances which affect our citizens' indus-tries,
property, health and lives, required by statute, recently has identified
these matters in this State.
To "show peculiar zeal" we must start with uniform terms. Members of
this Society and the North Carolina Governor's Council on Occupational Health
have agreed upon "occupational health" as the adequate protection and main-tenance
of the physical and mental health of every working person in order
to permit useful, productive work as he continues emotionally and psycho-logically
suited to his job.' An employee's health can be evaluated only by a
physician, practicing modern occupational medicine. "Industrial hygiene",
requiring scientific procedures of industrial hygiene surveys, recognizes, iden-tifies
and evaluates the work environments' factors which may or do cause
diseases in employees who would not be ill if not so exposed because of
their work.
Occupational health protects employees' personal health only when hazards
in their work environments are controlled. Such control differs from that used
against communicable diseases, chronic diseases, accidents, and other health
problems, because it is subject legally to so many third party controls of
differing legal, economic, and other origins. The third party is the employer,
legally charged with controlling the work environment.
The "productive population" comprises all adults employed in every gain-ful
manner, wherever they may be. Lack of occupational health jeopardizes
not only one individual of this productive population, but co-workers, and
the whole 2/3 non-productive population, hence the whole community. Thus,
the economic, educational, health, social and sociological status of the whole
community, their improvement or retrogression, is at stake.
Occupational health succeeds only after effectively applying preventive
medicine's industrial hygiene to work environments, and its occupational medi-cine
to its working persons. When preventions fail additional clinical medicine
must be provided on the job, but even more off the job, at the inevitably
NORTH CAROLINA BOARD OF HEALTH 31
increasing costs of therapeutic medicine, hospitalization, and rehabilitation.
Other detrimental community losses are mounting costs of compensation, sick-ness
or disability and other insurance benefits, and even death benefits. All
of these essential but scarcely amending gestures forecast consequent future
reductions in health protection.
Current technology compels expanding medical understanding of the chem-ical,
physical, and biological factors, eternally changing in our environments,
whose continually changing hazards can cause diseases acquired from air,
water, earth, foods, and the many work environs which must benefit and serve
us. Our employers pay many persons to engage in those public health programs
and preventive medical practices designed and known to protect the produc-tive
population from occupational diseases. However, they and all others con-trolling
community health resources, with medical guidance, also must engage
helpfully in the practices of preventive medicine. Occupational health, there-fore,
is an outstanding example of a community's pre-set "survival" stand for
private enterprise.
Occupational injury and disease, legally defined as well as defined by us
medically, may be relatively harmless, but they may cause disability. Dis-ability
also is defined both medically and legally. Regardless of how consistent
and beneficial these definitions may be, disability reduces or stops normally
gainful, productive work. Therefore, we must answer for unjustified medical
failures to prevent disability.
The nature of an occupational disease deserves special attention: its demon-strated
personal job exposure to the causative agent, with the known degree
and time required for personal response; its typical clinical effects known to
come from this agent; its lack of identification as something else; its pre-viously
proven capability of producing this response in man. Characteristically,
removal from exposure usually results in improvement. The personal effects
of occupational diseases are measurable; they can be evaluated, but only
by a physician.
Our 30-year old occupational disease program applied to a very few North
Carolina work places does protect the health of only a few employees.
Yet, our progress for over three centuries has depended upon the health of
the whole productive population, clearly limited by extent of their production,
income, purchase of goods and services, beneficial taxation, and most simply,
their votes. Hence, political attention is given increasingly to "medicine". We
may well ponder Disraeli's 1877 advice that "The health of the people is really
the foundation upon which all their powers as a State depend."
If you examine Table 1 filed with this report, you will find reflected numer-ous
Federal and 32 State Board of Health statutory responsibilities, grouped
administratively into three scientifically separate programs: (19 tables and 5
figures are available upon request in a supplement to this report.)
The oldest for 30 years has demanded industrial hygiene study of occupa-tional
diseases and direct diagnostic services to the North Carolina Industrial
Commission. This is a vital program which must continue even though too
late to protect any productive population's health. It is the only program we
can show significantly implemented to date.
32 FORTY-FIRST BIENNIAL REPORT
A second (eight years old) program requires preventive studies of job-cre-ated
(occupational) health hazards so as to eliminate or reduce them. Adequate
means have never been established for more than merely token compliance.
A third (six years old) program ostensibly protects the present and future
population effectively against somatic and genetic effects of ionizing radia-tion
exposures. However, the Board's authority to undertake this with respect
to 4/5 of all public radiation exposures was removed by a 1963 legislative
amendment even before the 1959 Act could be implemented by the Board,
or by any other agency.
Statutory priorities have limited industrial hygiene studies to 300 "dusty
trades" with some 7,000 employess only. This continually leaves only 1/5 of
our capabilities available for all remaining employers and 1.7 million em-ployees.
Must we have a crisis to improve this situation? Unfortunately in
previous public health needs the answer too frequently has been "yes". Yet,
Rene' Dubos has inquired two and a half centuries after Ramazzini, "Is it not
the responsibility of medicine to be concerned with the problems posed by
the long-range responses that the body and the mind make to the new threats
created by technological civilization?"
Does not medicine's long-range concern call first for measurements of
where we are now? Military occupational health failures long have been evalu-ated
by the status of "daily non-effectiveness". Every command applies the
standardized "non-effective rate", a general measure of the prevalence of all
disease and injury causing "excuse from duty status". The Army daily average
non-effectiveness is about one percent. Our own comparable civilian non-effectivness
probably is between three and five percent. To counteract non-effectiveness,
now and long-range, occupational health compels "medicine" to
do positive professional things about the socio-economic factors involved, and
employers to heed the medical and health significance of their work environ-ments,
and their own workers' personal health conditions.
To summarize to this point, then, our studies indicate we must evaluate
the whole population involved, the productive population, all health risks faced
at work, industrial hygiene controls of those risks, the effectiveness of occupa-tional
medicine for the productive population, and the whole community or
public health. All of these measure the community non-effectiveness, the
opposite of which is effectiveness. Occupational health is effectiveness.
Almost 2/3 of our whole population still live "rural". Our median age is
four years under the Nation's, yet life expectancy has increased nearly 16 years
since 1920. All of this controls our current "productive population", with
changing birth rates, with increase of those over 65, and with increasing female
to male ratio over 65.
The "productive population" must produce the future generations, educate
and serve present and later generations; maintain community continuity by
government; guide the future; and "research" the changes, the improvements,
and the increased productions, required.
At the turn of the century while the United States productive population
was 57 percent of the whole, small families assured that by 1940 it would be
NORTH CAROLINA BOARD OF HEALTH 33
near 65 percent. North Carolina's productive population today is some 61 per-cent,
the United States just over 50 percent. Thus, controlling factors for
Dubos' "technological civilization" have been our productive population's ages,
variable birth rates, mobility, urbanization, industrialization, mechanization,
automation.
Our agricultural workers comprise under 1/4 of the 1.7 million employed.
Our total non-agricultural employment, and our manufacturing employment,
have been increasing about 3 percent per year. Recent data show over 42 per-cent
of our non-agricultural employment now is in manufacturing.
In this framework agriculture, industry, and medicine are changing, are
ever more complex, and must adapt to the very rapidly increasing work en-vironmental
hazards to our people. North Carolina measurement of these
hazards, and the provision of control measures, are not increasing appreciably.
These circumstances assure disadvantages to all of us.
How can North Carolina afford economically not to protect and maintain
the health of its all-important productive population? With our manufacturing
and farm workers' earnings already considerably below national averages,
interruption reduces the family funds required to protect the entire family
health. Family medical care costs have risen; the total community economy,
unfortunately, has been reduced. The increased costs apply to every com-munity
interest.
For the costs of disability recall North Carolina's share of acute health
conditions at some 10 million persons in 1963. In 1961 every person 17 and
over averaged 5.4 work loss days. Our people have their share of the 74 mil-lions
having also one or more chronic diseases. The older the person over 44
years, the greater is the incidence. Our State Health Plan five years ago added
occupational health objectives clearly defining for the first time this matter,
and listed actions hopefully to benefit our aging productive population with
their increasing chronic illnesses.
The family outlay recently for personal health services to meet all these
acute and chronic family health problems is about five percent of their in-come.
Yet, the total expenditures for health and medical care showed a 24
percent increase from 1940 to 1960. What was purchased? The medical care
price index more than doubled between 1940 and 1961.^ The result? In North
Carolina, farm families have used less than half the treatment services they
needed; of the necessarily small amounts they spent for health, less than 4
percent has gone for diagnostic and preventive services. We don't even have
similar non-farm family expenditures data.
So much for the employee costs. What about the resultant increased costs
to our vulnerable North Carolina employer, for example on absenteeism, com-pensation
and medical care costs, production lags, reduced production, and
the costs of replacement of lost personnel? Personnel studies have revealed
the average cost of replacing an employee at $3,000!' Thus, every employee
kept healthy and on the job, selfishly, means more dollars to all of us.
No segment of our population has had its health so patently and generally
neglected as our 61 percent working adult age group. The remaining 39 per-
34 FORTY-FIRST BIENNIAL REPORT
cent have had gratifying attention. Very few of our working people have occu-pational
health programs.-* When or how else, can they possess health?
Table 2 of the supplement shows the likely distribution of the average
employee's weekly 168 hours. Then, Figure 1 shows why the only channels
"medicine" can keep open to this productive population in promoting their
health exists during their "8 to 5" work hours. Medical practice, hospitaliza-tion,
and health department services, are all available only these same hours,
except for true emergency to protect, maintain, or restore their health, or
rehabilitate them to effective productive capabilities.
Four years ago, the Vice President, North Carolina State Board of Health,
wrote several pertinent statements on this matter, of community responsibility
to the employer, of State Board of Health responsibilities. Doctor John R.
Bender, himself in practice, went on to state: ". . . this does not minimize the
obligation of the individual practitioner. Practicing physicians must also pro-vide
advice and local leadership for employers." The more a State Board of
Health may participate effectively in promoting occupational health, Doctor
Bender wrote, ". . . the more professionally gratifying and compensable will
be the private practice of medicine and the furnishing of health services by
practicing physicians."*
Is It not time now for "medicine" to examine itself? In 1962 only about
one percent of all United States medical specialists practiced occupational
medicine.* We find that the known full- and part-time North Carolina occu-pational
medical practices serve less than one percent of our productive
population. This is compatible with our latest Society Roster of Members
(December, 1964) where one can identify 68 "PH" (public health) physicians,
but only 17 "Ind" (industrial practice) and 7 "Ins" (insurance practice). All
of us know that, few as they are, more than 24 North Carolina physicians
engage in occupational medical practice. Why then, if not consciously con-cealing,
would our colleagues at the same time not openly declare their occu-pational
practices available?
To stabilize this occupational medicine itself, with pre-planned health
department and medical society supports, needs immediately to correct uni-versal
misconceptions of the medical practice and health departments by an
aggressive, factual, impressive educational program; help all physicians to
know complex ecological effects of changes occuring in agriculture, industry,
and medicine, so they can interrelate and apply to these changes their "know-how"
in preventive medicine; prove that what has been done up to now by
occupational health has been medically effective, rewarding, professionally
gratifying, and has improved some of our communities socio-economically;
convince physicians that compensation practice may be modestly remunera-tive,
but cannot benefit physicians, the victim, or the community equitably
when the disease or injury should have been prevented medically; persuade
more physicians and health departments to furnish aggressively those pre-ventive
services long ago over-due to their own people.
Irrefutable statement of some facts and candidly driving them home fear-lessly
to all of our colleagues is required. None can succeed alone. Health
departments must furnish clear concepts of the current health status, spot-
NORTH CAROLINA BOARD OF HEALTH 35
light lessons of the past, and periodically recommend the rapidly effective
and feasible undertaking by all of us for the future. While the remainder
of this report summarizes and places examples sharply in focus, only this
Society and the State Board of Health may determine jointly a future course
of effective responses. Come alive then—we are in the productive population
generation!
How can our society measure the North Carolina record? We have exam-ined
the causes of deaths, their numbers and rates, as heart, malignancy,
central nervous system vascular lesions, accidents, pneumonias. They do not
correlate with occupational disease incidents. We have given attention to
diminishing communicable and other diseases, to increasing traffic accidents,
to the numerous other but more adequate health programs. Yet, who can
remember one recent publication about increasing costs or medical implica-tions
of North Carolina occupational injury and illness of non-compensable
nature, or the workmen's compensation cases, as deaths or case incidence?
Infectious diseases will be here always, as a matter of changing biological
balances, between man and other organisms as well as the rest of the bio-chemico-
physical environment. But just think—during all of 1964 all of our
2,200 cases of those communicable diseases earning close watch" were only
1/4 as many as we averaged for occupational injury and illness reported to
our Industrial Commission every month; in 1964 there were only 1/4 as many
of all of these as there were cases of working people who proved compensable
under the Workmen's Compensation Act; less than 1/20 as many of these as
were injured in traffic (1581 killed, 49,124 injured in 1964).
To question further our imbalance in measuring health significance, keep
in mind that these traffic victims seldom elicit the sensational attention given
to just one serious injury or death due to a rare radiation accident. Similarly,
the 1964 occupational health problems, considerably out-numbering traffic and
significant communicable disease cases combined, are ignored.
Why does "medicine" not determine medically why our people have job-caused
injury or illness? Or why do people have nonjob-caused disabling
illness and injury? How will valid answers benefit our productive population,
our economic production, the individual employer or employee, their health,
their personal physicians? How shall we relate our answers to ever-changing
balances between work environment factors and individual personal factors
of the individual employee, and then provide Bender's "local leadership" to
protect his health? When Doctor John W. Morris reported last year in our own
Medical Journal on the 1962 Workmen's Compensation Act medical payments
of $25,000 daily,' who reported how much was because preventive medicine
and occupational health were "missing in action"? There were active accident
prevention programs. But both always will be necessary. How much did local
managements, physicians, and health departments use information furnished
to them about existing or new industries, or about State or local health depart-ment
services available to their own employees?
In 1964 there were nearly 99,000 on-the-job injuries and illnesses, and not
all are reflected. One hundred seventy-nine "fatal injuries" reported to our
Industrial Commission were due predominantly to falls, motor vehicles, and
36 FORTY-FIRST BIENNIAL REPORT
electrocution, but to "heart" with ever-increasing regularity. How many deaths
or cases were due to heart, other physical conditions of the employee, which
could have been medically predicted, diagnosed, averted, controlled, treated,
or otherwise neutralized?
Mere case incidence does not tell the sole management story nearly so
much as the differing rates of incidence for certain populations at risk in cer-tain
types of industry or with total costs to certain employers in these same
and other employee groups. Return to "heart" reports, then recall that 50
times more deaths in industry likely have occurred due to heart disease than
to industrial accidents.' Why shouldn't all result in "occupational disease"
compensation claims? Awards for such are increasing! No one can say what
or how much the occupations in our "technological civilization" have had to
do with this increasing heart, diabetes, arthritis, emphysema, other chronic
pulmonary disease, or cancer, morbidity. How can our State have economic
health with vacuous medical guidance?
Is the answer simple? Should not every employee have his personal health
status established clearly by a physician's pre-employment examination? When
justified, he should have special examination thereafter. Despite debated
value of periodic examinations, how else can later personal health status be
known? This is particularly significant because we have in prospect increasing
chronic diseases and aging population, and a larger proportionate productive
population.
Table 3 of the supplement shows you why four fifths of all State Board of
Health industrial hygiene studies required by statute serve less than one
hundredth of one percent of the non-agricultural employees in this State.
Successes of the remainder worth your attention are shown in Table 4 of the
supplement. If we could be ready, our new Research Triangle's Environmental
Health Center and the University of North Carolina million-dollar Institute of
Environmental Health Studies would support extensively our State's occupa-tional
health. But, we aren't ready.
Table 5 of the supplement summarizes data recently developed for the
Governor of Pennsylvania, who sponsored a conference on occupational pneu-moconiosis
in late 1964. Pennsylvania's death rate had been more than eight
times that of the whole United States for that disease, with over half of all
such deaths in this country in 1960. At Pennsylvania invitation Canadian,
British, and our North Carolina experience' were reported. The conference
concluded Pennsylvania cannot meet its responsibility merely by furnishing
diagnosis, treatment, compensation and insurance payments, to their pneu-moconiotics.
North Carolina employers know that we reported significant economics.
Four fifths of all compensation they had paid for preventable occupational
diseases had gone for pneumoconioses. However, less than 1/10 of the much
greater pertinent medical costs went to pay for medical treatment of these
two diseases. This means that over 9/10 of North Carolina millions paid out
for medical treatment of job-created injuries and illnesses has been due to
generally preventable circumstances which are receiving sparsely effective pre-ventive
medicine or occupational health attention. Table 6 shows our average
NORTH CAROLINA BOARD OF HEALTH 37
annual compensation and medical costs 1936 to 1940 were 1.6 million dollars
for over 40,000 people forced off the job by occupational injury and illness
every year. The annual compensation and medical costs for over 85,000 people
during each of the latest five years averaged 15.5 million dollars. Costs soared
at far greater rates than did any other measurable factor. How unjustifiably
is North Carolina now wasting its manpower, its health, therefore its produc-tivity,
its property, its economy, its lives? Some economic and social implica-tions
of these facts, which "medicine" should examine, follow.
As total cases have doubled, the compensation trebled, but medical costs
for the compensated employees went up five times. Where cases received no
workmen's compensation the medical costs only trebled! What consolation is
found in this? Even more unflattering medically, during each of the past five
years of modern "medicine" 85,000 employees have averaged 1/3 more days
lost per case per year than half that many experienced at the start of this
program 30 years ago. Recall, if you will, the income and health expenditure
data mentioned earlier. What advances can North Carolina "medicine" claim
here?
Our own State documentation proves that adequate occupational health
has given a few North Carolina employers opportunities to stay in equitable
competition with others. For example, the hazards of silicosis have been
reduced consistently by the cooperation given by some 300 "dusty trades"
employers. This 30-year program, required by law, has resulted in periodic
industrial surveys to protect employees from dust hazards of their work areas.
See Tables 7 and 8 of the supplement.
The law required also pre-employment and annual physical examinations
of all exposed employees, always with chest x-ray films, an estimated total
of 12,000 persons. Their results permit us to examine some socio-economic
effects of silicosis.
Table 1 showed six State agencies involved in this program, the State Board
of Health in the health aspects. Table 9 and Figure 2 of the supplement show
a few work environments selected at random where effective industrial hygiene
attention reveals markedly reduced silicosis health hazards. Figure 3 of the
supplement shows you that pre-employment and annual employee medical
examinations have reduced employee case incidence. These measures have
assured many more man-work years before silicosis was diagnosed. Due to
their longer employment, and older ages at diagnosis, greater retirement, social
security, and other benefits have accrued to these individual employees, their
families, and their communities, once diagnosed. We have demonstrated also
prospects of reduced workmen's compensation payments and medical care
costs, employees' replacement costs, and many expanded related benefits.
Figure 4 of the supplement shows all our silicosis diagnosed in the past
30 years. Nearly half exceeded the early or Grade I case in severity. Figure
5 of the supplement shows you that in the past five years only 1/4 have done
so, and in the past three years only 3 percent. By now a North Carolina dusty
trades employee has only 1/20 as much chance of a diagnosis of silicosis as
he had in 1935. There has been no case of silicosis diagnosed in North Caro-lina
during the past six months!
38 FORTY-FIRST BIENNIAL REPORT
We have identified the vulnerable employees, the hazards, and the cases.
We have ended harmful exposures of cases. We have progressed towards elim-ination
of silicosis, and added inevitable beneficial byproducts. For example,
Table 10 shows an annual average of 42 employees during the past five years
who learned of other previously undiagnosed serious pathology, predominantly
cardiac, and were referred promptly to their physicians for treatment. Table 11
shows we are examining the expanding problem of pulmonary emphysema.
See Tables 12 to 19 of the supplement for Examples "A" and "B" selected
from our records. These two firms summarize the pertinent points I have pre-sented.
Of course, exposure at different jobs within each firm, or between the
firms, have not at all been equally hazardous. With average age of the total
of 178 silicosis cases diagnosed the past ten years at 50, they were older for
the more severe cases. Consider "A", with average employment of about 300,
a plant where improved work environment has been evident, and "B" a firm
with average total employment about 70 where significant work environment
improvement has not been discernible. Very few of "A's" 46 cases had under
10 years exposure, 4/5 had more than 20 years. "B's" 37 cases showed clearly
the opposite. In the latest 10 years diagnosed "A" employees have averaged
21.5 years older than "B" employees. "A" profitted more than "B", by medical
examination and other measures, so that far fewer "A" cases had had prior
employment exposure than "B". "A" cases with prior employment exposure
had more than twice as long exposure during "A" employment as did similar
"B" cases during "B" employment. "A" profitted more than "B" in screening
applicants also with no prior employment exposure. Such "A" employees had
more than double the years of exposure, at times of initial diagnoses.
As a result of our study we know that identifiable worth-while preventive
measures have caused at least one serious, expensive, occupational disease
in North Carolina to be disappearing; this is because the likely serious hazards
of the specific work environment, and the risks of damaging individual em-ployees'
health, have been anticipated and measured by the employer wishing
to protect his individual employees' health, not true where an employer is not
so doing. To present one or more exceptions cannot impressively rebut the
facts. We have distinguishing honors to add to these factual achievements.
North Carolina "medicine" should be proud that since our last meeting our
fifth industrial medical program, Hanes Hosiery Mills Company, has been
awarded the prized Occupational Health Institute's Certificate of Health Main-tenance.
A month ago this same Company, through Mr. Gordon Hanes, Presi-dent,
received the Industrial Medical Association's 1965 Health Achievement
in Industry Award. This is only the second southeastern (1955), but the first
textile, and the first North Carolina industry, program ever to receive this
Award since its origin in 1949.
Dubos' "medicine" is not failing North Carolina's "technological civiliza-tion"
because we are scientifically or quantitatively lacking. We are failing,
however, and far more than justified. Where we fail, is it not because North
Carolina "medicine" does not sufficiently "show peculiar zeal" Ramazzini iden-tified
long ago as so necessary, ". . . in taking precautions for their safety,
so that as far as possible they may work at their chosen calling without loss
of health"?
NORTH CAROLINA BOARD OF HEALTH 39
There is hope. All but 420 of us in only 17 local medical societies have
ready-made channels for "zeal"; namely, our State Society's Committee on
Occupational Health and the 58 local Society Committees on Occupational
Health, all with designated and published chairmen. Yet, why does only one
local two-county society of over 350 members have no designated chairman,
when never before have we had so many local chairmen serving so many as
we do this year?
The State needs both expanded occupational programs and more industrial
hygiene services. What prospect of failure has "medicine" if our State and
local committees will be our active agents, will recruit joint actions by their
own members and local employers, local health departments, and the State
Board of Health staff, in their support, and if "medicine" will lead the State
to increased preventive medical and industrial hygiene services? None, be-cause
even at this late date vigorous occupational health action by "medicine"
can assure North Carolina's competitive stature in this day of "survival" eco-nomics.
Let not Ramazzini have reason to haunt us!
REFERENCES
1. North Carolina Governor's Council on Occupational Health: "Better Occupational Health
for North Carolina," Raleigh, Published by the Council, 1960.
2. Goldfield, E. D.: "Statistical Abstract of the United States," 83rd Annual Edition, Wash-ington,
U. S. Government Printing Office, 1962, P.76 (Table No. 88); P.77 (Tables
No. 89 & 90); P.87 (Table No. 106); P.238 (Table No. 314).
3. Anon.: Heart Research Opens New Dimensions to Industry, "Occupational Hazards":
P.21-24 (Feb.) 1965.
4. Wilson, W. L.: Many Want Occupational Health, "Archives of Environmental Health":
3:7-8 (July) 1961.
5. Bender, J. R.: The "Forgotten Man" in Total Health; Influence of a State Board of Health,
"Archives of Environmental Health": 3:14-16 (July) 1961.
6. Wathen, F. P.: Physicians Specializing in Occupational Medicine, "Journal of Occupational
Medicine": 6:288-292 (July) 1964.
7. Nick Elliott: North Carolina Is Still Winning War Against 10 Deady Diseases, "The Raleigh
Times," P.I 5 (Feb. 8) 1965.
8. Morris, J. W.: Workmen's Compensation: Its Philosophy and Application, "North Carolina
Medical Journal"; 25:155-159 (April) 1964.
9. Wilson, W. L.: The North Carolina Pneumoconiosis Prevention Program in Dusty Trades,
read before Pennsylvania Governor's Conference on Pneumoconiosis, Harrisburg Penn-syvania,
November 30, 1964.
FORTY-FIRST BIENNIAL REPORT
CONJOINT SESSION
May 4, 1966—Address by Jacob Koomen, M.D., M.P.H., State Health Director
This is the time when we annually report on the stewardship entrusted by
the Society and the citizens of North Carolina to the State Board of Health.
I recall to you the fact that the State Board of Health is a nine member
body, four coming out of the Society and five appointees of the Governor.
Those from the Society are Dr. Goodwin, Dr. Raper, Dr. Hiatt and Dr. Steiger,
all well known to you for their achievements within the Society and outside of
it. The Governor's appointees are: Dr. Baker, whom you have just heard intro-duced
with the appropriate praise due his achievements; Dr. Dawsey who repre-sents
so well the veterinary profession; Dr. Cline, representing in like manner
the dental profession and Mr. Lackey who represents the dairy interests of
the state—all extremely important areas in the health field.
In presenting a brief accounting of what has been done, I should like to
mention first, that this year brought the retirement of Dr. J. W. R. Norton
as State Health Director after a period of nearly 18 years in this office—
a
period of phenomenal growth and phenomenal progress. He will be with the
State Board of Health in the future as Director of Local Health Services.
The year of course has been an exciting one. Because, perhaps at least
in my lifetime and yours as well, this is an era of great revolution in research,
in knowledge, and in all the fields of health that have to do with prevention,
with cure and with rehabilitation. Your Society, as reflected in those of us
who belong to it, as reflected in the citizens, as reflected in your responsibili-ties,
are all in this dynamic period of change and progress. Further than that,
we share the anxiety over the truly terrible shortage of manpower and we
look for ways of extending the arms of those already working.
The North Carolina State Board of Health is involved in some thirty pro-grams.
Many of these touch you frequently, some touch you each day. We have
been well supported by the Board and, we trust the reverse is true, that we
have supported them in like manner.
I should like now briefly to talk about the functions of the various Divi-sions,
hitting only the high spots. In discussing thirty programs, obviously it
is not possible to mention them all and we have in turn from year to year
talked about one function or another.
I should like to give you a general overview of what is going on in public
health in North Carolina.
First, I have to mention the matter of money. There is, of course, not enough
spent on health; there will be more in the future. North Carolina, as you know,
is the nth most populous state and one which expects to have 5,000,000 people
in September of this year. In the domain of direct public health our State spent
$19,600,000 during the last fiscal year. This represents an increase of better
than $3,000,000 over the year before.
NORTH CAROLINA BOARD OF HEALTH 41
Perhaps surprisingly, an increase of better than $800,000 came out of in-creased
appropriations by local bodies. Public health is very well supported
by the citizenry at the county level.
Our staff has grown, the State staff now stands at a level of 432 staff mem-bers
and the Local Health Departments have another 1,500 working close to
those they serve. North Carolina has one of the largest public health organiza-tions
in the Nation as suits its particular health needs. And, if I might say so
as an outsider, it also has the best.
We distribute, as you know, THE HEALTH BULLETIN, with a circulation of
47,000 per month.
We have a Public Health Library of our own and more than 8,000 visitors
were recorded there last year.
Our Film Library—known to all of you since you are frequent borrowers from
it, as are the colleges, the schools and the churches—had a circulation of
almost 43,000 films last year.
The recording of data in an organization such as ours leads to astronomical
numbers of pieces of literature, important ones like birth certificates and
death certificates, and all of our correspondence. Of these we had more than
277,000 pieces permanently recorded. And I might say that, lest you feel this
is an outgrowth of red tape in North Carolina government, it is not. North
Carolina government is a superbly efficient, smooth-running government; vir-tually
devoid of the sort of criticism, perhaps I should say devoid of this sort
of criticism, which one so often thinks of in the sort of American humor that
has to do with red tape. Our governmental system is efficient and simple and
there is no red tape, in my estimation.
In the matter of publications we supply to the citizens, we publish not
only THE HEALTH BULLETIN, but a great number of items on particular dis-eases
and conditions in our state.
I move now to the Division of Dental Health. Let me say, as preamble, that
in a presentation before the Advisory Budget Commission one year, I discovered
that were the dental health as it ought to be for North Carolina children,
those in the first six grades would be expected to have some 17,000,000 teeth
altogether.
Think of the opportunity in the field of dentistry. Think of the number of
dentists we have and, like all health professionals, how many more we need.
But they work desperately to correct, to cure and to prevent. And I'll have
something to say later about prevention. Not only in the personal office pre-vention
sense of the word but, as you know, at the State Board of Health we
have a reasonably large staff of dentists who function with the schools in pre-vention
programs and illustrate some curative aspects. Here too we have
expanded so that we now have an internship in public health in dentistry. An
increasing number of dentists are turning to public health as a career and
their importance is being recognized.
42 FORTY-FIRST BIENNIAL REPORT
Last year for the first time we had a Federal appropriation specifically
geared to dental needs. We have had interest in oral cancer and through these
programs and with the cooperation of the practicing dentists five cases of oral
cancer were discovered in 1964 and fifteen in 1965.
And finally of great interest to us all, the dentists together with the engi-neers
and other North Carolinians have combined to push the use of fluoride
in the water whenever this is possible. Every effort is put forth to enhance
and increase the number of communities using it. There are now some 84
towns which fluoridate their public water supply. These cover a population
of about 1.4 million and we can now state that 31% of the population is cov-ered
by fluoridated water supplies.
I could go on, but in the interest of time let me turn to a third of our
seven divisions, Epidemiology.
Now the term Epidemiology is a broad one and has to do with events among
the people and quite clearly all of man's endeavors would fit into this. At the
State Board of Health the Division of Epidemiology performs many of the
functions filled by Divisions in other states which are labeled Divisions of
Preventive Services.
The Division of Epidemiology works in Communicable Disease, in Occupa-tional
Health, in Radiation Protection, Tuberculosis, and Venereal Disease.
It records the births and the deaths, the marriages and divorces. And it is
interested in Accident Prevention.
But among the things that were looked into this past year were the matters
of a large epizootic of Eastern encephalitis; a follow-up program of all birth
certificates to insure the fact that North Carolinians be adequately immunized
against those diseases for which childhood prevention is possible.
We looked also into a follow-up of the smallpox vaccinations to see what
kinds of reactions we were getting. At the State Fair this past year, in cooper-ation
with the Medical Society, a booth was maintained for the tetanus im-munization
of those who would stop by. A great many were immunized and
this proved to be a successful project.
There is more to be said. As you know, there is an epidemic of syphilis
nationally, but this has been controlled and halted in North Carolina. And
further than that, venereal disease control and instructions have been given in
a number of school systems. We have modernized, so to speak,—modernized
is perhaps not the word—but we have put in a new Tuberculosis Program
in line with national suggestions.
Because of wide spread increase in drownings in the state, the State Board
of Health is concerned. We lose too many from drowning, often in multiples.
There were a number of drownings in the past year in which four died simul-taneously.
We followed these up along epidemiological lines.
Of course we worked closely with the education system, whether this be
at the elementary school level, the high school or the college level, in imple-menting
our programs with them.
NORTH CAROLINA BOARD OF HEALTH 43
All of the birth certificates prior to 1945 have been microfilmed and, last
year to add to our armamentarium, we had 97,000 births, 42,000 deaths, 40,000
marriages and 11,000 divorces.
I might inject a note here; the common statistical data which says that
one out of every four marriages is dissolved by divorce would appear to be
borne out by a casual glance at our data with 40,000 marriages and 11,000
divorces. Let me say, however, that this is a false statistical base, it is not the
40,000 who married one year out of which 11,000 are divorced.
The 11,000 that were divorced come out of all of North Carolina's marriages
accumulated as of that time and the fracture rate there for marriage is far
lower than the one previously given as one in four.
Let me say a word about the Laboratory, a large organization, a four story
building, processing more than 650,000 specimens a year. Highlighted should
be the fact that, in cooperation with Personal Health, a new program to follow
up the possible occurrence of phenylketomuria was begun. This proved to be a
highly successful program. You know that in the management of this metabolic
defect if this can be discovered early enough, important destructive effects
can be prevented. Further than that, there is a great saving of personal and
public money which would be needed to maintain those who become mentally
defective if not adequately treated in time.
Because of interest around air pollution, water and occupational health
chemistries, the role of our chemistry program also increased. Again this year,
the amount of cancer cytology, especially cervical cytology, became more
important.
The infectious diseases, all of which have been with us since man began,
had more precise techniques applied. Advance was made in the management
of streptococcal diseases and syphilis.
I cannot speak without saying some words about our Local Health Divi-sion,
the Division of which Dr. W. Burns Jones had been Director until he
came into the role of Acting Assistant State Health Director, a very important
role in the State. Dr. Norton will succeed him in the changes that have taken
place.
In North Carolina we have had for nearly twenty years a Local Health De-partment
for each of our counties. Some of these, of course, are combined in
neighboring counties for the sake of efficiency, with a good Health Director
serving several counties. But here too the role is one of increase in service.
We do have, unfortunately, a considerable number of vacancies. In this area
there are too few people in the health profession, a shortage felt world-wide
and felt therefore among our health directors. We wish there were more health
directors available. We look for expanding their efforts.
In cooperation with the Economic Opportunity Act, we have been educating
people in the health education field. We have done a great deal of education
within the nursing groups through self-teaching systems by correspondence.
Then too, we have for emergency purposes stored in the State some fifty
disaster packaged hospitals, so that should a huge emergency occur these
44 FORTY-FIRST BIENNIAL REPORT
can be unpackaged and used. These are 200 bed hospitals and are prepositloned
around the state for disaster purposes. Fortunately we've not had to use them.
We have helped to sponsor a course in medical self-help so should there
be a great disaster those who are not close to medical care could assist with
help and carry on, we hope, through systems of self-care.
We have been working in the field of migrant health, important in North
Carolina. Not only do we take from the migrant stream, but we add to it.
Many crop harvests are dependent in part upon these migrant workers.
Through increased sanitation and working in this area we have made definite
improvements.
I come now to the Division of Personal Health, of which Dr. Jim Donnelly, a
member of the Society, is Director. There are programs in crippled children.
In correction of defects, the School Health Coordinating Service which is done
between our organization and the Department of Public Instruction.
While more might be said, perhaps at this point a word would be timely
about our relationship to Medicare. This will be a program at the Federal level
and concerns those of us in the State who relate to it.
In size the Medicare program is difficult to project. There are more than
367,000 North Carolinians who will be eligible for this by virtue of the fact
that they will be 65 or over when it begins. In addition to that, all of the health
personnel will be affected as will the institutions with which they associate.
This is not to mention the fiscal intermediaries, Pilot Insurance for Part B
and the Blue Cross Family for Part A. This will touch the lives of all of us,
our families, our elders and our institutions.
Excellent progress is being made in our North Carolina program. We are
told that we are as far along in this as the guidelines will permit, and we are
already off to a good and running start, though always one would wish to be
farther along. We are off to a good running start because we have a good
agency licensing hospitals in this' state. We have a high proportion of hos-pital
beds already accredited by the Joint Commission on Hospital Accredita-tion.
These will virtually automatically be certified.
The three C's in which we work are Certification of Institutions, Consulta-tion
with them as they wish or ask for aid in how to proceed should they wish
to participate, and, finally. Coordination. For these institutions will need agree-ments
with each other, ordinarily only one with another, so patients may be
efficiently transferred from hospital to extended care facilities, to home care
programs.
I had opportunity to discuss this at length at the first general session on
Monday, but let me add as a final word, that we are told that we are as far
along as can be at this time. Your State Board of Health is dedicated to
having this, as is the Society, the best Medicare program in the United States.
We have had superb cooperation, and I use the word advisedly, between
our policy making Board of which Dr. Baker is President, and other members
are in the audience, and the State Medical Society, the N. C. Hospital Associa-tion
and such others as have direct relationship with the Blue Cross people.
NORTH CAROLINA BOARD OF HEALTH 45
I continue with a few closing remarks.
The last of our seven Divisions is the Sanitary Engineering Division.
It has been said, and I believe wisely, that more freedom from Communic-able
Disease has been bought and brought to us by sanitary measures than
by any other. Whenever we increase our cleanliness, our education, improve
our housing, improve all of those things in the broad scope of human welfare
and when we begin to think of sanitation we improve man's lot. Sanitation
increases his life, increases his freedom from disease and increases his use-fulness.
For that reason, among the oldest public health measures are those
designed to improve the environment around us. In these days you know that
includes not only cleaning it up in the microbiological sense of the word and
making it free of disease but, in addition to that, the term sanitation already
includes and will include in the future, beautification of the environment as
well. Beautification is often no more expensive than any other system and
is sometimes cheaper.
The Sanitary Engineering Division, in long and vigorous action, looked
with great pains at many water supplies this past year, some 156 were added
to those already in existence. We now have a total of 887 water supplies under
supervision. As I noted earlier, 86 towns now have fluoridation of water.
We have looked at many restaurants, as you know when you travel through
North Carolina. You see in our restaurants the grading signs. Those of you
who have traveled considerably look first at grade signs for the large blue A,
because this tells you much about the institutions. You see it posted in hos-pital
lobbies, too, applying only to the kitchen, of course.
In many years of effort and in close cooperation with the restaurant in-dustry
the food service in North Carolina has been made a fine one.
In the matter of some of our specialized areas, for instance the matter of
shellfish, there we worked for a long time with those who are in charge. Now,
however, we have an arrangement between us, more legal and helpful than the
former one which had been in use for some forty years. Our present inspection
program is one in which we have manpower and in which we can apply
specialized abilities and have funds to carry it out. North Carolina is an im-portant
shellfish state.
We work with the growers and operators of Migrant Labor Camps. Those of
you who are familiar with them in years past know that persons oriented to
sanitation would quickly see much to be done. Here too we find that when
sanitation is improved the condition

UNC-CH HEALTH SC!
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Cfte JLititatp
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Dean I. M. Taylor
Forty-first Biennial Report
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
July 1, 1964-June 30, 1966
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NORTH CAROLINA BOARD OF HEALTF
MEMBERS OF THE STATE BOARD OF HEALTH
Appointed by the Governor
LENOX D. BAKER, M.D., President
Appointed 1956
Term expires 1969
A. P. CLINE, SR., D.D.S.
Appointed 1965
Term expires 1969
BEN W. DAWSEY, D.V.M.
Appointed 1959
Term expires 1967
SAMUEL G. KOONCE, Ph.G.
Appointed 1963
Term expires 1967
J. M. LACKEY
Appointed 1965
Term expires 1969
Elected by the Medical Society of the State of North Carolina
JAMES S. RARER, M.D., Vice-President
1^ Elected 1963
1?; Term expires 1967
i-^^ OSCAR S. GOODWIN, M.D.
Elected 1950
Term expires 1967
JOSEPH S. HIATT, JR., M.D.
Elected 1965
Term expires 1%9
HOWARD PAUL STEIGER, M.D.
Elected 1965
Term expires 1969
N
^^
^ EXECUTIVE STAFF AS OF JUNE 30, 1966
JACOB KOOMEN, JR., M.D., M.P.H.,
^^ Secretary and State Health Director
(Term expires June 30, 1967)
W. BURNS JONES, JR., M.D., M.P.H.,
Assistant State Health Director
(Term concurrent with the State Health Director)
;^ J. M. JARRETT, B.S., Director, Sanitary Engineering Division
MARTIN P. HINES, D.V.M., M.P.H., Director, Epidemiology Division
J. W. R. NORTON, M.D., M.P.H., Director, Local Health Division
E. A. PEARSON, JR., D.D.S., M.P.H., Director, Dental Health Division
THEODORE D. SCURLETIS, M.D., Acting Director,
Personal Health Division
LYNN G. MADDRY, M.S.P.H., Ph.D., Director, Laboratory Division
BEN EATON, JR., LLB., Director, Administrative Services
EDWIN S. PRESTON, M.A., LLD., Public Relations Officer and
Editor, THE HEALTH BULLETIN
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NORTH CAROLINA BOARD OF HEALTH 5
LOCAL HEALTH DIRECTORS IN NORTH CAROLINA
Department Health Director Address and Telephone Number
Alamance—Dr. W. L. Norville, Burlington, N. C. 27218—227-7451 (919)
Alleghany-Ashe-Watauga*—Dr. Mary B. H. Michal, P. O. Box 268, Boone, N. C. 28607
267-2711 (704)
Anson—Dr. Phillip H. Creech, P.T., P. O. Box 473, Wadesboro, N. C. 28170—694-2516 (704)
Avery—Newland, N. C, 28657—733-4971 (704)
Beaufort—Dr. W. A. Browne, Washington, N. C. 27889—946-3101/946-3102 (919)
Bertie—Dr. Karl Van Horn, P. O. Box 397, Windsor, N. C. 27983—794-2161 (919)
Bladen—Dr. Caroline Callison, P. O. Box 188, Elizabethtown, N. C. 28337—862-3467 (919)
Brunswick—Dr. J. R. Black, Southport, N. C. 28461—457-2081 (919)
Shallotte, N. C. 754-6611 (919
Buncombe—Dr. H. W. Stevens, P. 0. Box 7607, Courthouse, Asheville, N. C. 28807
252-7611, ext. 242 (704)
Dr. Irma H. Smathers, P. O. Box 7607, Courthouse, Asheville, N. C. 28807
252-7611, ext. 242 (704)
Burke—Dr. G. F. Reeves, P. O. Box 945, Morganton, N. C. 28655—437-5152 (704)
Cabarrus—P. O. Box 1149, Concord, N. C. 28025—782-4121 (704)
Caldwell—Dr. William Happer, P. O. Box 777, Lenoir, N. C. 28645—754-4241 (704)
Carteret—Dr. Luther Fulcher, P.T., Beaufort, N. C. 28516—728-4557
*Catawba-Lincoln-Alexander—Hickory, N. C. 28601—345-3883 (704)
*Cherokee-Clay-Graham—Murphy, N. C. 28906—837-2311 (704)
Cleveland—Dr. Z. P. Mitchell, P. O. Box 138, Shelby, N. C. 28150—487-8561 (704)
Columbus—Dr. J. R. Black, P. 0. Box 786, Whiteville, N. C. 28472—642-4145 (919)
Craven—Dr. W. A. Browne, New Bern, N. C. 28561—637-3121/637-3122 (919)
Cumberland—Dr. M. T. Foster, P. O. Box 470, Fayetteville, N. C. 28302—483-1336 (919)
Currituck—Dr. W. W. Johnston, Currituck, N. C. 27929 —453-2238 (Coinjock) (919)
Dare—Dr. W. W. Johnston, P. O. Box 476, Manteo, N. C. 27954—473-2480 (919)
Davidson—Dr. Dermot Lohr, P. O. Box 522, Lexington, N. C. 27292—246-5952/246-5953 (704)
*Davie-Yadkin—P. O. Box 457, Mocksville, N. C. 27028—634-2012 (704)
Duplin—Dr. John F. Powers, Kenansville, N. C. 28349—296-2666 (919)
Durham—Dr. O. L. Ader, 300 E. Main Street, Durham, N. C. 27701—682-8176 (919)
Edgecombe—Dr. J. S. Chamblee, Tarboro, N. C. 27886—823-2174/823-2175 (919)
Forsyth—Dr. James A. Finger, P. O. Box 2975, 720 N. Ridge Avenue, Winston-Salem, N. C.
27102—723-8811 (919)
Franklin—Dr. J. B. Wheeless, P.T., P. O. Box 300, Louisburg, N. C. 27549—496-3553 (919)
Gaston—Dr. B. M. Drake, P. O. Box 819, Gastonia, N. C. 28053—864-4331 (704)
Granville—Dr. J. U. Weaver, P. O. Box 1002, Oxford, N. C. 27565—693-7618 (919)
Greene—Dr. Joseph L. Campbell Snow Hill, N. C. 28580—747-3578 (919)
Guilford—Dr. E. H. Ellinwood, 300 E. Northwood Street, Greensboro, N. C. 273-9425 (919)
Dr. Sarah T. Morrow, Asst., 300 E. Northwood Street, Greensboro, N. C. 273-9426 (919)
Halifax—Dr. Robert F. Young, Halifax, N. C. 27839—583-2191 (919)
Harnett—Dr. Melvin F. Eyerman, P. O. Box 36, Lillington, N. C. 27564—893-3425 (919)
Dunn, N. C. 892-2424 (919)
Haywood—Dr. Raymond K. Butler, Waynesville, N. C. 28786—456-3542 (704)
Henderson—Dr. J. D. Lutz, P.T.. P. O. Box 150, Hendersonville, N. C. 28739—692-4223 (704)
Hertford-Gates-Dr. Quinton E. Cooke, Winton, N. C. 27986—358-3191 (919)
Hoke—Dr. Harry H. McLean, P.T., P. O. Box 638, Raeford, N. C. 28376—875-3717 (919)
Hyde—Dr. W. W. Johnston, P. O. Box 254, Swan Quarter, N. C. 27885—926-3566 (919)
Iredell—P. O. Box 1268, Statesville, N. C. 28677—873-7271 (704)
*Jackson-Macon-Swain—Sylva, N. C. 28779—586-2913 (704)
Johnston—P. O. Box 711, Smithfield, N. C. 27577—934-4168 (919)
Jones—Dr. John A. Parrott, Trenton, N. C. 28585—448-2701 (919)
Lenoir—Dr. John A. Parrott, 200 Rhodes Avenue, Kinston, N. C. 28501
523-6110/523-6119 (919)
McDowell—Dr. W. F. E. Loftin, Marion, N. C. 28752—695-6471 (704)
Madison—Dr. Margery J. Lord, P.T., Route 5, Box 231, Marshall, N. C. 28753—649-3531 (704)
Martin—Dr. Karl Van Horn, P. O. Box 546, Williamston, N. C. 27892—792-4133/792-4134 (919)
Mecklenburg—Dr. Maurice Kamp, 1200 Blythe Blvd., Charlotte, N. C. 28203—375-8861 (704)
Dr. Eliz. C. Corkey, Asst., 1200 Blythe Blvd., Charlotte, N. C. 28203 (375-8861 (704)
6 FORTY-FIRST BIENNIAL REPORT
Department Health Director Address and Telephone Number
Mitchell-Yancey*—Burnsville, N. C. 28714—682-2127 (704)
Montgomery—Dr. G. H. Armstrong, P.T., P. O. Box 275, Troy, N. C. 27371—576-4251 (919)
Moore—Dr. Alfred Siege, Carthage, N. C. 28327—947-2711 (919)
Nash—Dr. J. S. Chamblee, Nashville, N. C. 27856—459-2158 (919)
New Hanover—Dr. C. B. Davis, P. O. Box 1491, Wilmington, N. C. 28402—762-1863 (919)
Northampton—Dr. W. R. Parker, Jackson, N. C. 27845—534-3071 (919)
Onslow—Dr. Eleanor Williams, P. O. Box 246, Jacksonville, N. C. 28541
347-2154/347-2155 (919)
*Orange-Person-Chatham-Lee-Caswell—Dr. O. David Garvin, Chapel Hill, N. C. 27514
942-4169 (919)
Dr. C. S. Fuller, Asst., Chapel Hill, N. C. 27514—942-4169 (919)
Pamlico—Dr. W. A. Brow^ne, Bayboro, N. C. 28515—745-2506 (919)
*Pasquotank-Perquimans-Camden-Chowan—Dr. Isa Grant, Elizabeth City, N. C. 27909
335-5429
Pender—Dr. N. C. Wolfe, P.T., Burgaw, N. C. 28425—259-2563 (919)
Pitt—Dr. R. E. Fox, P. O. Box 680, Greenville, N. C. 27834—752-4141/752-4142 (919)
Randolph—Dr. H. C. Whims, P. 0. Box 267, Asheboro, N. C. 27203—625-4227 (919)
Richmond—Dr. L. Thomas Morton, Rockingham, N. C. 28379—895-6304 (919)
Robeson—Dr. E. R. Hardin, P. O. Box 1088, Lumberton, N. C. 28358—739-3344 (919)
Rockingham—Dr. C. T. Mangum, P.T., Spray, N. C. 27352—623-6173 (919)
Reidsville, N. C. 27320—349-6533
Rowan—Dr. M. K. Holler, P. O. Box 1487, Salisbury, N. C. 28144—633-0411 (704)
*Rutherford-Polk—Dr. T. F. Hahn, Rutherfordton, N. C. 28139—287-4931 (704)
Sampson—Dr. Caroline Callison, Clinton, N. C. 28328—592-6177 (919)
Scotland—Dr. L. Thomas Morton, P. O. Box 72, Laurinburg, N. C. 28352—276-1411 (919)
Stanly—Dr. George M. Leiby, P. O. Box 707, Albemarle, N. C. 28001—982-4615 (704)
Stokes—Dr. J. S. Taylor, P.T., Danbury, N. C. 27016—593-7611 (919)
Surry—Dr. Robert Caldwell, P. O. Box 1267, Mount Airy, N. C. 27030—786-4163 (919)
Transylvania—Dr. John R. Folger, P.T., P. O. Box 666, Brevard, N. C. 28712—883-4255 (704)
Tyrrell-Washington*—Dr. Claudius McGowan, P.T., Plymouth, N. C. 27962—793-4416 (919)
Union—Dr. C. A. Bolt, P. O. Box 23, Monroe, N. C. 28110—283-6124 (704)
Vance—Dr. J. U. Weaver, P. O. Box 571, Henderson, N. C. 27536—438-4714 (919)
Wake—Dr. M. B. Bethel, P. 0. Box 949, Raleigh, N. C. 27602—833-1655 (919)
Dr. Jane H. Wooten, Asst., P. O. Box 949, Raleigh, N. C. 27602—833-1655 (919)
Warren—Dr. Lloyd H. Harrison, P.T., P. O. Box 157, Warrenton, N. C. 27589—257-3373 (919)
Wayne—Dr. Carl Hammer, P. O. Box 1537, Goldsboro, N. C. 27530—735-4331 (919)
Wilkes—P. O. Box 30, Wllkesboro, N. C. 28697—838-5591 (919)
Wilson—Dr. Joseph Campbell, Wilson, N. C. 27896—237-3141 (919)
CITY DEPARTMENT
Rocky Mount—Dr. J. S. Chamblee, 1616 W. Thomas Street, Rocky Mount, N. C. 27803
442-5181, ext. 270 (919)
REGIONAL OFFICE
Western Regional Office
N. C. State Board of Health
Biltmore Plaza Office Building
Asheville, N. C. 28803
253-8424 (704)
District Headquarters Corrected December 1966
NORTH CAROLINA
JACOB KooMEN MD MPH STATE BOARD OF HEALTH
STATI «E.LT« DI.ICTO. P O BOX2091
.NosicReT..v-T.,AsuR.. RALEIGH. NORTH CAROLINA 27602
/ BURNS JONES. JR.. M.D . MPH.
December 15, 1956
The Honorable Dan K. Moore
Governor of North Carolina
The State Capitol
Raleigh, North Carolina
Dear Governor Moore:
Pursuant to the provisions of Chapter 130, Article II,
Paragraph 12, General Statutes of North Carolina, I herewith
submit to you, and through you to the General Assembly of
North Carolina, the Biennial Report of the North Carolina
State Board of Health for the fiscal years of July 1, 1964
to June 30, 1966.
Respectfully submitted,
Kjacob Koomen, M.D., M.P.H.
State Health Director
JK:dps
MEMBERS OF STATE BOARD
LENOXO BAKER MO, PRESIDENT- DURHAM BENW DAWSEV D V M - GASTON
,
A
Tr".'-jKZ^°°^"2Zool^nV''°''''''
JAMES RARER MD V IC E PRESI DENT - ASH EV 1 LLE OSCARS GOODWIN M D - APEX J M LACKEY - RT ^ "'""'~"'
Tp Il,NE SR D O S - crN?ON JOSEPH S H.ATT JR . M D - SOUTHERN P,NES HOWARD PAUL STE.OER. M O - CHARLOTTE
CONTENTS
State Board of Health Members and Executive Staff 3
Administrative Organization 4
Local Health Directors 5
Letter of Transmittal 7
Report of Secretary-Treasurer and State Health Director
Abridged Minutes of State Board Actions 9
Dec. 3, 1964—page 9 May 5, 1965—page 17
Aug. 26, 1965—page 19 Dec. 2, 1965—page 24
(Special Session—Dec. 2, 1965—page 27)
May 4, 1966—page 28
Conjoint Sessions
May 5, 1965—Address by William L Wilson, M.D 30
May 4, 1966—Address by Jacob Koomen, M.D,, M.P.H 40
State Health Director 47
Division Reports
Administrative Services Division 48
Division of Epidemiology 52
Laboratory Division 67
Local Health Division 70
Charts—pages 81-92
Dental Health Division 93
Personal Health Division 96
Sanitary Engineering Division 98
Report of the Committee on Postmortem
Medicolegal Examinations 105
Public Health Chronology—1964-1966 108
References given for similar reports 1877 through 1964
REPORT of the SECRETARY-TREASURER and
STATE HEALTH DIRECTOR
Abridged report of the activities of the State
Board of Health as recorded in the Minutes
December 3, 1964
A regular meeting of the North Carolina State Board of Health was held
Thursday, December 3, 1964, 1:00 p.m. to 4:00 p.m., in the Board Room of the
Cooper Memorial Health Building, President Lenox D. Baker, M.D., presiding.
The following members were present:
Dr. Lenox D. Baker, President
Dr. John R. Bender, Vice President
Dr. Ben W. Dawsey
Dr. Glenn L. Hooper
Dr. Oscar S. Goodwin
Mr. D. T. Redfearn
Dr. James S. Paper
Dr. John S. Rhodes
Absent:
Mr. Samuel G. Koonce
The meeting was called to order by President Baker, and the invocation
pronounced by Dr. Oscar S. Goodwin.
On motion of Dr. Glenn L. Hooper, seconded by Dr. Ben W. Dawsey, the
minutes of the May 6, 1964, Board meeting were approved as circulated by
the Secretary.
President Baker asked all members to stand in silent tribute while Dr.
J. W. R. Norton, State Health Director, read the following resolution for adop-tion
by the N. C. State Board of Health, in memory of the late Robert D. Hig-gins,
M.D., Director of the Local Health Division, State Board of Health, who
passed away October 9, 1964:
RESOLUTION OF APPRECIATION AND RESPECT
Robert Donald Higgins, M.D., M.P.H.
"WHEREAS, the sudden and untimely death of Dr. Robert Donald Higgins,
Director of the Local Health Division, has brought profound sorrow to his many
friends and associates, and
"WHEREAS, the State Board of Health, wishing to give recognition to his
influence and invaluable service and to express its sense of loss m his passing
and its grateful appreciation of his great spirit and many virtues, does hereby
set forth this formal resolution of respect.
"A native of Ironton, Ohio, Dr. Robert Donald Higgins received his under-graduate
education in the Crabbe School in Ashland, Kentucky, and at the Uni-versity
of Kentucky. He received his medical degree from the University of
Louisville and his Master of Public Health degree from Harvard University.
10 FORTY-FIRST BIENNIAL REPORT
"He served with distinction as Assistant Surgeon in World War I.
"For forty-three years he had been active in public health, serving in several
important administrative capacities in Kentucky, Florida and North Carolina.
His first service was with the State of Kentucky as Director of the Boyd County
Health Unit and later he served as Director of the Volusia County Health Unit
in Florida.
"On February 1, 1957, he joined the staff of the North Carolina State Board
of Health as Assistant Director of the Local Health Division. Since February 1,
1958, he served as Division Director.
"As an able administrator, valued friend, a master organ and piano player,
joyous comrade, he will live in the hearts of those who knew him—especially
those friends in North Carolina, and in the Southern Branch and national
fellowships of the American Public Health Association.
"BE IT THEREFORE RESOLVED, that this expression of respect and appre-ciation
be formally enacted by the State Board of Health, and spread on its
official minutes, and that a copy be forwarded to the family of our departed
friend to convey, even though inadequately, the sincere sympathy of the mem-bers
of the State Board, and
"BE IT FURTHER RESOLVED, that copies be also sent to the Editor, the
North Carolina Medical Journal; the Editor, Journal of the American Medical
Association; the Editor, the Journal of the American Public Health Association;
the Editor, The Bulletin, American Association of Public Health Physicians;
the Editor, Newsletter of the American College of Preventive Medicine; the
Secretary, the Medical Society of the State of North Carolina; the Secretary,
the North Carolina Public Health Association, and to the Director, the Depart-ment
of Archives and History.
"This the third day of December, 1964."
In relation to a request from the Orange-Durham County Medical Society
for the Board's views regarding requirement of tetanus immunization for
initial issuance of a driver's license and subsequent renewals. Dr. Jacob
Koomen, Jr., Assistant State Health Director, presented a discussion of North
Carolina's present tetanus experience. Dr. Goodwin moved, and Dr. Rhodes
seconded, a motion that the Board approve such a requirement. Motion was
passed unanimously. This action is to be reported to the Orange-Durham
County Medical Society so that it may, in turn, report favorable action to the
State Medical Society. If the State Medical Society approves, the Attorney
General's Office will be asked to draw up a bill for presentation to the coming
legislative session.
Mr. Samuel J. Hawkins, Director of the Emergency Health Preparedness pro-gram
gave a summary of the emergency preparedness program, which was
created to coordinate all services that might be needed in times of disaster
and was delegated to the State Board of Health through the Governor's Office.
Most of these activities are in natural disasters, hurricanes, etc. The most
tangible items of civil defense are the 48 to 200 bed emergency hospitals, and
he showed a map of these hospitals. The next major step is to develop some
type of training for use of these hospitals. In regard to the medical self-help
program. North Carolina has not done as well and is actually lagging in the
number of people trained.
Governor Terry Sanford made a brief visit to the meeting of the State
Board, and in welcoming him, Dr. Baker said, "It is a privilege to have you
come to attend the last meeting which we will hold while you are serving as
NORTH CAROLINA BOARD OF HEALTH 11
Governor of the State of North Carolina. I know of no man who has been
Governor of the State of North Carolina who has done a better job. May I say
you are one of the finest governors, and please tell Mrs. Sanford we think she
has been a wonderful First Lady. We recognize that you have an incurable
disease—that of unselfish dedication to service of your fellownnan. We have
no plans for developing a vaccine against this relatively rare disease."
Governor Sanford said: "Dr. Baker, I am certainly glad to have a chance to
come and meet with this Board. I have tried to keep in touch and to be of
assistance every time you and Dr. Norton called and I have enjoyed working
with the staff members in a number of programs. I have not been attending
board meetings because there are some 157 State boards and commissions.
But I have watched with more than passing interest the many things that
have been done.
"As you may know, Dr. Norton and I come from the same sandhill section of
North Carolina. In fact, we both come from along about the place where Drown-ing
Creek turns into Lumber River. I have certainly known him and he has
known my family for many, many years, I suppose since he was a young boy.
And, so again, I have had a special interest in what was going on here and
special appreciation for what was being done.
"I do not like this business of coming to the end of an administration. I
do not like this business of going around and saying that the time has come
to say goodbye. I can't quite figure out what the proper approach is. In any
event, I did not want to get out of office without expressing my appreciation
and thanks.
"I think a lot of progress has been made. It has been made in many things
that deal with the well-being of the people. Almost everything your Board
does relates to people and their position in life and their capabilities. I think
we could have a little better philosophy of the State if we concerned ourselves
with people and did what we could to put them in a little better position to
fulfil! their capabilities.
"So this agency is typical of what all agencies should be concerning them-selves
with and that is how can we better develop the human resources of the
State. With that, I again say that I am very grateful for the association I have
had with all of you."
Dr. Baker recognized Mr. Thomas W. Lambeth, Administrative Assistant, who
accompanied the Governor.
Dr. Martin P. Hines, Director of the Epidemiology Division, discussed the
major changes in the direction of the new tuberculosis control program of the
State Board of Health, including the discontinuance of the mass Xray mobile
survey program as carried on in the past. He stated that mass Xray surveys
would be discontinued after December 31, 1964. On behalf of the Board, Presi-dent
Baker welcomed Dr. Hines as a new division director.
Dr. J. W. R. Norton, State Health Director, reported on the meeting in Chi-cago
of the National Conference on Medical Aspects of Driver Safety and Driver
Licensing sponsored by the American Medical Association and the Public
Health Service. After discussion, the Board instructed the staff to study ways
12 FORTY-FIRST BIENNIAL REPORT
in which legislation may be needed to promote traffic safety and to give full
support to such constructive legislation as may be sponsored by the Depart-ment
of Motor Vehicles or other agencies.
Dr. Edwin S. Preston, Public Relations Officer, gave a brief review of the
legislative proposals made by the State Board of Health to the 1963 General
Assembly. He indicated that all five of the proposals made at that time were
enacted. A recent request from Governor-Elect Dan K. Moore, for legislation
which was being planned for presentation to the 1965 General Assembly was
circulated to division directors at Dr. Norton's request. No definite proposals
for specific health legislation in the forthcoming General Assembly were
thought to be needed at this time.
Dr. Preston also reviewed briefly the centralized plan for legislative informa-tion
and service which was in effect at Dr. Norton's request in the Public Rela-tions
Office during the 1963 Session of the General Assembly. A mimeographed
sheet presenting this plan was circulated and is filed with the minutes as be-ing
the plan to be used during the coming session. This legislative informa-tion
and service will be available to Board members, State staff and local
health directors. The report was received as information.
Dr. Koomen reported on and discussed the advisability of establishing a
much needed regional public health laboratory facility in the western part of
the State in Asheville. North Carolina is now served by the State Laboratory
in Raleigh. It was noted that it takes several days for specimens to reach
Raleigh from, and reports to be returned to, the far western end of the State.
In the discussion, it was noted that one reason for considering the establish-ment
of a regional laboratory was that the erection of a State office building
in Asheville has been proposed. It was pointed out that several other states
have regional public health laboratories. On motion of Dr. Paper, seconded
by Dr. Hooper, Dr. Norton was instructed to study further the feasibility of
establishing this regional laboratory in Asheville and give a report at the next
Board meeting. Motion carried.
President Baker recognized Mr. Ben Eaton, Jr., Director of Administrative
Services, and cordially welcomed him back on the staff of the State Board of
Health. Mr. Eaton had been granted a leave of absence from the State to
accept a position with the Public Administration Service in Afganistan in
1959. He later served in Peru with North Carolina State College, and has re-turned
to the Board after this five-year absence.
Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, presented a
petition for a proposed extension of the boundary lines of the Royal Oaks
Sanitary District in Cabarrus County. He stated that all documents and trans-actions
had been carefully examined by his office and were, in his opinion, in
order and in compliance with the law, and he recommended that the State
Board of Health authorize this request for extension of the sanitary district.
On motion of Mr. Redfearn, seconded by Dr. Hooper, the RESOLUTION OF THE
NORTH CAROLINA STATE BOARD OF HEALTH EXTENDING THE BOUNDARY
LINES OF THE ROYAL OAKS SANITARY DISTRICT IN CABARRUS COUNTY,
NORTH CAROLINA, was carried.
NORTH CAROLINA BOARD OF HEALTH 13
Mr. Jarrett also presented a request for the extension of the boundary lines
of the Rural Hall Sanitary District. He stated that the documents, as well as
the various transactions relative to this matter, had been examined by his office
and were in order, and he recommended favorable action by the Board to
annex the proposed territory. On motion of Dr. Hooper, seconded by Dr. Good-win,
the RESOLUTION OF THE NORTH CAROLINA STATE BOARD OF HEALTH
EXTENDING THE BOUNDARY LINES OF THE RURAL HALL SANITARY DIS-TRICT
IN FORSYTH COUNTY, NORTH CAROLINA, was passed.
Also, Mr. Jarrett presented a request for the dissolution of the Dare Beaches
Sanitary District in Dare County. He stated that the Dare Beaches Sanitary
District was created in 1948; the Town of Nags Head is now incorporated and
the Sanitary District has, therefore, served its purpose. Therefore, it is re-quested
that the State Board consider favorably the dissolution of the Dare
Beaches Sanitary District as requested in the petition. He stated that all pro-cedures
were in order, and he recommended that the dissolution request
be authorized by the Board. It was moved by Dr. Goodwin, seconded by Dr.
Rhodes, that the RESOLUTION OF THE NORTH CAROLINA STATE BOARD
OF HEALTH DISSOLVING THE DARE BEACHES SANITARY DISTRICT IN DARE
COUNTY, NORTH CAROLINA, be authorized. Motion carried.
Then, Mr. Jarrett presented a suggestion for revision in Form No. 451—In-spection
Form For Restaurants and Foodhandling Establishments. He recom-mended
the deletion of the words, "facilities adequate for each sex and race"
in Item 6 in the Form, and to insert in place of the above "facilities adequate
to meet Labor Department rules." He explained that the Labor rules would
make use of this same terminology in its new regulations and Mr. Jarrett recom-mended
that this change be made in our Form No. 451, On motion of Dr. Daw-sey,
seconded by Dr. Raper, the recommended change was approved.
Mr. Jarrett also reported on a proposed revision of rules and regulations
governing the sanitation of meat markets, abattoirs, frozen food locker plants,
and poultry processing plants. On motion of Dr. Hooper, seconded by Dr. Daw-sey,
the REVISED RULES AND REGULATIONS GOVERNING THE SANITATION
OF MEAT MARKETS, ABATTOIRS, FROZEN FOOD LOCKER PLANTS, AND
POULTRY PROCESSING PLANTS, was approved. These revised rules and regu-lations
to become effective July 1, 1965.
At the conclusion of Mr. Jarrett's presentation of items. Dr. Baker com-mented
on the long and efficient service which Mr. Jarrett has rendered to
public health in North Carolina and to this Board. He commended Mr. Jarrett
for the excellent manner and form in which the Sanitary Engineering recom-mendations
have been presented to the Board throughout Mr. Jarrett's long
years of service. Dr. Hooper moved and Dr. Raper seconded this sentiment, and
by acclamation the Board gave its unanimous approval of this expression of
appreciation and gratitude.
Mr. W. Gordon Poole, Chief of the Nursing Home Section, presented several
items for consideration and approval by the Board relative to appointments of
members to the Nursing Home Advisory Council to the State Board of Health:
14 FORTY-FIRST BIENNIAL REPORT
(1) Miss Ethel Harrison, R.N., Chapel Hill, to succeed Mrs. Nan Cummings.
Miss Harrison is Assistant Director of Nursing Service at N. C. Memorial Hos-pital;
a member of the Committee on Nursing Care of the Chronically III and
Aged, and currently is Co-Chairman of this Committee. On motion of Dr. Raper,
seconded by Dr. Hooper, the recommendation of Miss Harrison's appointment
was approved.
(2) Mr. Lloyd Gilbert's nomination by the N. C. Hospital Association to suc-ceed
Mr. Joseph Barnes was recommended. Mr. Gilbert is Administrator of the
Johnston Memorial Hospital, Smithfield. On motion of Dr. Goodwin, seconded
by Dr. Rhodes, Mr. Lloyd Gilbert was approved as a member of the Nursing
Home Advisory Council of the State Board of Health.
(3) Dr. D. A. McLaurin, Garner, was re-nominated by the Medical Society of
the State of North Carolina to succeed himself. Dr. McLaurin is a member of
the Chronic Disease Committee of the Medical Society. On motion of Dr. Raper,
seconded by Dr. Hooper, Dr. McLaurin's appointment as a member of the Nurs-ing
Home Advisory Council to the State Board of Health, was approved.
The above nominees are for a three-year term to expire in 1967.
Mr. Poole reported to the Board that Mr. Everett C. Carnes, Attorney to the
Nursing Home Advisory Council—term expiring in 1965, had resigned because
of too many conflicts and professional duties. It was moved by Dr. Hooper,
seconded by Dr. Goodwin, that this resignation be accepted and that this posi-tion
remain unfilled for the present. It was so ordered. It was suggested by the
Board that a letter of thanks be written to Mr. Carnes for his services rendered
during his term of service.
At the request of the Nursing Home Advisory Council, Mr. Poole recom-mended
to the Board that a representative of church and fraternal homes be
included on the Council. On motion of Dr. Goodwin, seconded by Dr. Dawsey,
the request to include a representative from church and fraternal homes was
carried.
Also, Mr. Poole reported that it was recommended by the Nursing Home
Council that it be enlarged in membership by including a representative of
Foundations and Endowments. After discussion, it was moved that the Duke
Endowment submit a nominee and then a mail vote be taken of the Board
members so that the one appointed can begin his term immediately. Motion
made by Dr. Goodwin, seconded by Dr. Rhodes, and carried.
Mr. Poole reported that Dr. Ellen Winston who was an ex-officio member of
the Nursing Home Advisory Council had left the State. Therefore, it was rec-ommended
that the "Commissioner of the State Board of Public Welfare" be
substituted as an ex-officio member. It was moved by Dr. Rhodes, seconded by
Dr. Goodwin, that this replacement be accepted, and that a letter of apprecia-tion
of Dr. Winston's services be written to her. Motion carried.
Mr. George M. Stephens, Jr., Governor Terry Sanford's Special Assistant,
reported on a study that was done this summer which Governor Sanford con-siders
to be of great long-range interest to the State. He distributed copies of
NORTH CAROLINA BOARD OF HEALTH 15
this report "Strategy for Development" and three articles. He stated that sev-eral
seminars have been held on human resources, natural resources and eco-nomic
development. He indicated that the study recommended:
(1) That the long-range planning division already authorized in the Depart-ment
of Administration be activated.
(2) That rather than trying to have all of the planning for the State Govern-ment
operations going on in that unit, that every effort be made to encourage
the agencies of State Government to do their own advance planning and think-ing
so that they can work together and with the Governor even more effectively
on programs for the future.
(3) That the State use the most modern systems that are available for the
collection and analysis of information, including computers.
(4) That the State establish a rational program for working with the regional
planning development associations and groups.
Governor Sanford has endorsed these recommendations and has appointed
a committee of leading citizens and State agency heads to help him get them
carried out. This committee is at the point of recommending initial staff, at
least a director who could head the planning division. Money is being arranged
for and also arrangements are being made for transition into the next adminis-tration.
Mr. Stephens stated that the plan has the endorsement of Governor-
Elect Dan K. Moore.
President Baker, on behalf of the Board, commended Dr. Edwin S. Preston,
Public Relations Officer, on the excellent manner in which he has presented
publicity, news coverage, etc., of the State Board of Health, the staff and the
public health program. He referred particularly to the coverage in The Health
Bulletin of the transfer of licensing and enforcement authority from the Atomic
Energy Commission to the State of North Carolina to be administered by the
State Board of Health.
Dr. W. Burns Jones, Director of the Local Health Division, who is on loan
for three months to assist with the North Carolina Fund and Economic Op-portunity
Program, was present and briefly reviewed as information the purpose
and programs which have been developed in these organizations thus far. On
behalf of the Board, Dr. Baker welcomed Dr. Jones as a new Division Director,
Dr. D. Frank Milam, Chief of the Cancer-Heart-Chronic Disease Section, re-ported
briefly on action taken on request of the Bertie County Hospital for
approval under the State Cancer Program. The Hospital's request was denied
due to failure of this hospital to comply with regulations requiring that Xray
equipment and radium for the treatment of cancer be provided. On request of
the hospital superintendent, the matter was referred to the Chronic Disease
Committee of the Medical Society of the State of North Carolina which sets up
regulations for the cancer programs. At the September meeting of this com-mittee,
the action by the State Board was upheld. Dr. Milam's report was ac-cepted
as information and no action was needed.
16 FORTY-FIRST BIENNIAL REPORT
Dr. Hooper called attention to the Christmas decorations of the Board Room
and thanked Mrs. Edwards, Mrs. Tetterton and Mrs. Mouser for this thoughtful
courtesy.
Mr. Redfearn stated that he had been approached by county managers rela-tive
to the possible greater use of administrative assistants in the local health
departments. The matter was discussed but no action taken.
Mr. Redfearn also commented on the continuing need for avoiding undue
work by local health departments in preparation of complicated reports. Copies
of the rules under which our Permanent Records Committee operates to assure
appropriate handling of this problem were distributed to Board Members.
Mr. Ben Eaton, Jr., Director of Administrative Services, spoke briefly con-cerning
the biennial budget requests of the State Board of Health for 1965-
1967, and of the recent Federal allotments for the fiscal year, 1964-1965.
It was pointed out that the Department has not as yet received any informa-tion
as to action taken by the Advisory Budget Commission on the "B" Budget
requests, which are $1,541,818 for 1965-1966 and $1,626,081 for 1966-1967, or
a total of $3,167,899. Aid to counties through the Local Health Division is the
number one priority in this request. It was emphasized that the counties and
Local Health Departments would receive over 84% of the "B" Budget request
if the "B" Budget receives favorable action by the Legislature. Members of the
Board were urged to give their support through contacts with Legislative repre-sentatives
to the Department's budget proposals.
The Board was advised of the Federal Grant Funds recently made available
to the Department for the year 1964-1965. The overall allocation resulted in
an increase of $248,299 over the year 1963-1964. Virtually all of this increase
came from the large increases in the grants of Maternal and Child Health and
Crippled Children, whereas substantial reductions occurred in the grants to
General Health, Heart Disease, Cancer, Chronic Disease and Venereal Disease.
In General Health alone there was a reduction of $150,000 over the preceding
year. Thus, there is a significant shift in Federal grant policy from formula
grants to grants for special projects or programs.
Dr. Glenn Hooper reported on the advisability of changing the present name
of the "Oral Hygiene Division" of the North Carolina State Board of Health. He
stated that Dr. E. A. Pearson, Jr., the Director, had been concerned for some
time about such a change because a large number of citizens in North Caro-lina
do not understand the true meaning of the words "Oral Hygiene". Quite
often the lay person does not associate the words "oral hygiene" with "dental
health." Another confusion about the name has been experienced in com-munications
both by telephone and letter. For these reasons Dr. Pearson had
recommended to the Board for their consideration a change of the name of
this division from the name "Oral Hygiene Division", to "Dental Health Divi-sion".
On motion of Dr. Hooper, seconded by Dr. Paper, the Board unanimously
approved the change of name as requested to "DENTAL HEALTH DIVISION".
Dr. Baker asked for a clarification of the circumstances surrounding new
funds which are available in the field of mental retardation. It was brought to
NORTH CAROLINA BOARD OF HEALTH 17
Dr. Baker's attention that the funds available in this area are a part of the
regular formula funds through Maternal-Child Health and Crippled Children.
Recent Federal legislation has increased these grants with the provision that
at least one-third of the additional money must be spent on children who have
mental retardation as a significant part of their problems.
On motion duly made and seconded, the Board adjourned about 4:00 p.m.
May 5, 1965
The annual meeting of the North Carolina State Board of Health was held
during the annual meeting of the Medical Society of the State of North Caro-lina
in the Charlotte Merchandise Mart, Charlotte, North Carolina, Wednesday,
May 5, 1965, 8:00 a.m. to 9:15 a.m. Dr. Lenox D. Baker, President of the Board,
presided.
Attending: Lenox D. Baker, M.D.
Ben W. Dawsey, D.V.M.
Glenn L Hooper, D.D.S.
Oscar S. Goodwin, M.D.
D. T. Redfearn, B.S.
James S. Raper, M.D.
Samuel G. Koonce, Ph.G.
John S. Rhodes, M.D.
Absent: John R. Bender, M.D.
Also present was Dr. Howard Paul Steiger of Charlotte, newly elected by
the Medical Society of the State of North Carolina to the Board and who will
take his Oath of Office at the next meeting.
In addition to the Board members, staff members present included: Dr.
J. W. R. Norton; Dr. Jacob Koomen, Jr.; Dr. Martin P. Hines; Dr. Edwin S. Pres-ton;
Mr. John Andrews; Mr. Gordon Poole, and Dr. George Leiby of Johnston
County. Mr. John H. Ketner, Co-Director of the North Carolina Ambulance
Service Study, was also present.
Dr. Baker gave the invocation. The minutes of the last meeting were ap-proved
as circulated.
Dr. Jacob Koomen, Jr., Assistant State Health Director, presented the pro-posal
of a branch laboratory in the western part of the State. He said that
currently 17% of the specimens now being processed in the State Laboratory
originated in western North Carolina. He indicated that it would take approxi-mately
$300,000 to provide an adequate building with equipment and staff for
the first year. Thereafter, the yearly cost would not include the capital expendi-tures.
He stated that there were a number of factors which would need to have
further study before it could be determined whether it was both necessary
and feasible to have such a branch laboratory. The type of specimens, whether
or not they deteriorate because of time in shipping, the availability or
strengthening of county and private laboratories were amongst the factors
which Dr. Koomen indicated should be considered before any wise decision
could be made.
18 FORTY-FIRST BIENNIAL REPORT
Dr. Martin P. Mines, Director of the Epidemiology Division, presented the
two-year study which has resulted in proposed legislation (not yet introduced)
concerning ambulance service regulations. Mr. John H. Ketner, Co-Director of
the North Carolina Ambulance Service Study, was present and participated
in the discussion. Dr. Baker raised a number of questions concerning the pro-visions
of the bill which seemed to give the County Commissioners the respon-sibility
for private ambulance business and might result in a confusing lack of
uniformity in services. It was moved by Dr. Hooper, seconded by Mr. Redfearn
and passed, that the State Board of Health supports the principles set forth
in the bill and will continue in cooperation with the morticians in following
through with their efforts to assure the availability and accessibility of ambu-lance
services throughout the State.
Mr. John Andrews of the Sanitary Engineering Division, recommended re-visions
to the Rules and Regulations Governing the Sanitation of Private Hos-pitals,
Nursing Homes, Rest Homes, Sanitariums, Sanatoriums, Educational and
other institutions. On motion of Dr. Dawsey, seconded by Dr. Hooper, these
revisions were approved. {Copies filed in Minute Book)
Mr. Andrews presented two resolutions for the extension of the boundary
lines of the YANCEYVILLE SANITARY DISTRICT, CASWELL COUNTY. He
stated that the annexation of the proposed territory, documents, as well as the
various transactions relative to this extension, had been examined by the
Sanitary Engineering Division and were in order, and he recommended favor-able
action by the Board. On motion of Dr. Hooper, seconded by Dr. Goodwin,
the two resolutions for the extension of boundary lines of the Yanceyville
Sanitary District in Caswell County, North Carolina, were passed. (Copies filed
in Minute Book)
A proposal to allow recreational activities on GRAHAM CITY RESERVOIR
was also presented by Mr. Andrews. On motion of Dr. Rhodes, seconded by Mr.
Redfearn, the resolution authorizing the City of Graham to permit controlled
fishing and other controlled recreational activities on the City's Reservoir, was
approved. (Copy filed in Minute Book)
Dr. Hooper moved that the body endorse the proposals and program of Gov-ernor
Moore with regard to highway safety. Dr. Hooper's motion was seconded
by Dr. Rhodes, and carried.
Dr. Baker introduced Howard Paul Steiger, M.D., Charlotte Dermatologist,
one of the two newly elected members to the State Board of Health. Joseph
Spurgeon Hiatt, Jr., M.D., Internist of Southern Pines, the other newly elected
Board member by the Medical Society of the State of North Carolina, was not
present at the meeting.
The Board expressed its regret in losing Dr. Rhodes and Dr. Bender from
the Board's membership after the next Board meeting, and expressed thanks
to them for their services.
The Board also expressed its deep regret at the passing of Dr. D. Frank
Milam on April 6, 1965, and asked that a resolution of respect and appreciation
be prepared by the staff for presentation at the next Board meeting.
NORTH CAROLINA BOARD OF HEALTH 19
The Board adjourned to the Conjoint meeting where Dr. Wayne Benton for
the IVledical Society, and Dr. Lenox D. Baker, for the State Board, presided.
Dr. William L Wilson presented the Conjoint Report entitled, "Can 'Medi-cine'
Overtake Technological Civilization?"
August 26, 1965
The regular quarterly meeting of the North Carolina State Board of Health
was held Thursday, August 26, 1965. At 11:00 a.m. the Board met for the oath-taking
ceremony of new Board members in the Hall of the House of the Capi-tol
Building. The invocation was given by The Rev. T. Marvin Vick, Jr., D.D.,
of the Edenton Street Methodist Church. Governor Dan K. Moore welcomed
the many friends, including members of the staff of the Board, for the cere-mony.
Chief Justice Emery B. Denny of the Supreme Court of North Carolina,
administered the Oaths of Office to the following for four-year terms on the
Board of Health:
Governor Dan K. Moore's Appointees
Lenox D. Baker, M.D., (G), 1969—Durham (Re-appointed)
A. P. Ciine, Sr., D.D.S., (G), 1969—Canton
J. M. Lackey, (G), 1969—Route 2, Hiddenite
Elected by the Medical Society of the State of North Carolina
Joseph S. Hiatt, Jr., M.D., (S), 1969—Southern Pines
Howard Paul Steiger, M.D., (S), 1969—Charlotte
The benediction was given by The Rev. Vick.
Following the oath-taking ceremony in the Capitol Building, the members of
the Board proceeded to the Cooper Memorial Building for a regular executive
session in the Board Room,
Attending: Dr. Lenox D. Baker; Dr. James S. Raper; Dr. Ben W. Dawsey;
Mr. Samuel G. Koonce; Dr. Oscar S. Goodwin; Dr. A. P. Cline, Sr.; Dr. Joseph S.
Hiatt, Jr.; Mr. J. M. Lackey, and Dr. Howard P. Steiger.
President Baker presided. The meeting was called to order and the invoca-tion
pronounced by Dr. Baker, after which the new members were introduced
and greeted.
On motion duly made and seconded, the Minutes of the Board Meeting
held on May 5, 1965, were approved as circulated by the Secretary.
President Baker announced that it was time for the election of officers and
a new Executive Committee of the Board for two-year terms ending in 1967
consisting of a President, Vice-President, and two additional Board Members.
Dr. Ben W. Dawsey moved, seconded by Dr. A. P. Cline, Sr., that Dr. Lenox
D. Baker be re-elected as President. Motion unanimously passed.
Dr. Oscar S. Goodwin moved that Dr. James S. Raper be nominated to serve
as Vice-President of the Board. Motion seconded by Dr. Dawsey, and carried.
20 FORTY-FIRST BIENNIAL REPORT
It was moved that Dr. Dawsey and Mr. Samuel G. Koonce be nominated to
serve on the Executive Committee of the Board. Motion seconded, and unani-mously
carried.
Dr. Edwin S. Preston, Public Relations Officer, presented a "Resolution of
Appreciation and Respect" for Dr. D. Frank Milam, who passed away April 6,
1965. Dr. Milam was a member of the Board's staff in the Personal Health
Division. Dr. Goodwin moved that the Resolution be adopted by the Board and
made a part of the records of the State Board of Health. Motion seconded by
Dr. Dawsey, and carried. Copy of the Resolution follows:
RESOLUTION OF APPRECIATION AND RESPECT
Dr. Daniel Franklin Milam
1894-1965
"The death of Dr. Daniel Frank Milam on April 6, 1965, ended a career in
public health which covered more than forty years and three continents.
"Dr. Milam was born in Leesburg, Florida, on May 12, 1894. After primary
education in Kentucky and Florida, Dr. Milam attended Stetson and Vanderbilt
Universities.
"It was only after his service as an Ensign in the Navy during World War I
that Dr. Milam entered the field of medicine at the University of Chicago
Medical School, receiving his M.D. degree in 1923. He received the Master of
Public Health degree from Johns Hopkins University. He served his intern-ship
in 1922-'24 and then went with the Rockefeller Foundation.
"Service with the Foundation took Dr. Milam to Poland, Austria, Canada,
Czechoslovakia, Lebanon, the Virgin Islands, the Philippine Islands, and many
parts of the United States. Included in his tenure with the Foundation was
service in North Carolina, assigned as a Consultant to the State Board of
Health. He first came here in 1932 when he was instrumental in locating the
first cases of Rocky Mountain Spotted Fever in this State. With the assistance
of Dr. Joseph C. Knox, now a Wilmington Pediatrician, he organized the Com-municable
Disease Program which later became the Division of Epidemiology.
For six years, Dr. Milam made a study of the nutritional status of the Bynum
(Chatham County) and certain other rural communities in North Carolina. These
studies were conducted through the Research Departments of Duke University
of North Carolina.
"During this twenty-five years of service. Dr. Milam pioneered in studies on
human nutrition and related subjects. Mrs. Milann has many mementos of their
years in foreign service in their home in Chapel Hill.
"After his retirement from the Rockefeller Foundation, he served as Na-tional
Director of the Planned Parenthood Federation for two years (1948-'50).
In 1950, he became Medical Director of the New York Heart Association, a posi-tion
he held until 1959.
"He then returned to North Carolina as Chief of the Heart, Cancer and
Chronic Disease Sections, where he served so ably until his death. During
his administration of these responsibilities, the areas have progressed in an
outstanding way in this State, matching progress in any other state in the
Nation.
"Dr. Milam was author of a score of articles in medical journals over the
years of his service in public health. He was a Fellow of the American Medical
Association, of the American Public Health Association, and of the New York
Academy of Medicine. He was licensed to practice medicine in Illinois, Florida,
New York, and North Carolina.
NORTH CAROLINA BOARD OF HEALTH 21
"Dr. and Mrs. Milam made their home in the Morgan Creek area of Chapel
Hill. Dr. Milam married Mary Louise Wilson in 1924. They have four children—
a daughter, Mrs. R. P. Creed, New York, N. Y.; and three sons, all of them
medical doctors, Dr. John H. Milam, Winchester, Va.; Dr. D. F. Milam, Jr.,
Bellevue, Washington; and Dr. R. W. Milam, McAllen, Texas. Dr. Milam is also
survived by two brothers, George W. and E. B. Milam, both of Jacksonville,
Florida.
"Because few men have had such long services in public health and few
have served in so many areas of public health; because Dr. Milam was a versa-tile
and dedicated public health physician and yet still had time to be a
patient and kind person; because no one could have regarded him as anything
but the fine gentleman he was; and because of the personal affection he gen-erated
and deserved and his devotion as a public health worker, he will be
missed.
"THEREFORE, BE IT RESOLVED, that this expression of respect and appre-ciation
be formally enacted by the State Board of Health and spread upon its
official Minutes, and that a copy be forwarded to the family of our departed
friend to convey, though inadequately, the heartfelt sympathy of the members
of the State Board, and
"BE IT FURTHER RESOLVED, that copies be also sent to the Editor, North
Carolina Medical Journal; the Editor, Journal of the American Medical Associa-tion;
the Editor, Journal of the American Public Health Association; the Secre-tary,
Medical Society of the State of North Carolina; the Secretary, North
Carolina Public Health Association; to the executives of the Rockefeller Foun-dation;
and of the other organizations with which he was associated.
"This twenty-sixth day of August, 1965."
Dr. Jacob Koomen, Jr., Assistant State Health Director, discussed the
present status of the health related aspects of the Appalachian Regional Com-mission.
Under the Act, multi-county health facilities may be built and staffed.
Soon a twenty-four member committee will be appointed, half by Governors
of States involved, to study the health needs of Appalachia to determine fu-ture
course of action in establishing the multi-county health facilities.
Next, Dr. Koomen presented items relating to Title XVIII of the recently
amended Social Security Act—Public Law 89-97. Each Governor is to designate
the State Agency to work with the Social Security Administration in the im-plementation
of Title XVIII. The responsibilities of the State Agency includes,
as pointed out in the Association of State and Territorial Health Officers News-letter,
June 25, 1965:
"1. Certification that providers (hospital, nursing homes, and home health
programs) meet the established standards;
"2. Providing consultation and assistance in establishing utilization review
staff committees in each institution to review both the quality of care
and the length of stay of patients; and
"3. Providing consultation which will assist hospitals, nursing homes, and
home health programs to participate in the program."
It was brought out that the State Board of Health already carries out some
of these functions and that its present role relates closely to others. Data and
information available to the State has been sent to the Governor's Office. Dr.
Norton has also talked with members of the Governor's staff and the Presi-dent
of the Board, Dr. Lenox D. Baker, has been in communication with Gover-nor
Dan K. Moore.
22 FORTY-FIRST BIENNIAL REPORT
Mr. J. M. Jarrett, Director, Sanitary Engineering Division, presented for con-sideration
by the Board rules and regulations relating to the sanitation of
shellfish and Crustacea. The 1965 General Assembly passed an Act clarifying the
authority of the State Board of Health to regulate the sanitation of harvesting,
processing and handling of shellfish and Crustacea. The Bill directed the State
Board of Health to prepare and enforce regulations. The regulations presented
were the same as in effect prior to July 1 under the authority of the Com-mercial
Fisheries Division of the State Department of Conservation and Devel-opment,
the only change being made in the previous regulations were editorial
changes to comply with the amended law. He recommended the adoption of
these regulations by the Board. Dr. Dawsey moved the adoption of the proposed
RULES AND REGULATIONS RELATIVE TO THE SANITATION OF SHELLFISH
AND CRUSTACEA, as amended. Motion seconded by Dr. Goodwin, and carried.
(Copy attached)
Also, Mr. Jarrett presented and discussed minor changes and amendments
to update the RULES AND REGULATIONS PROVIDING FOR THE PROTECTION
OF PUBLIC WATER SUPPLIES. After consideration by the Board, Mr. Koonce
moved adoption of the proposed amendments. Motion seconded by Dr. Cline,
and carried. (Copy attached)
Dr. Theodore D. Scurletis, Chief of the Maternal and Child Health Section,
Personal Health Division, gave an interim report on the Laboratory for the
screening of metabolic diseases. He stated that through the combined efforts
of the Laboratory Division and the Maternal and Child Health Section, a labora-tory
unit was established for the screening of inborn errors of metabolism.
To-date the program has progressed through a development stage during which
the best time to apply this type of screening procedure on the newborn was
established. Screening for all newborns for PKU will begin November 1 and
this is being announced at present. An advisory committee of biochemists
and pediatricians is guiding the development of this program and it is hoped
that this will lead to screening for detection of other metabolic errors as
soon as feasible. The present cost of this test is about thirty cents (.30(;') which
is about one-third the cost of any other test mechanism. The procedure in-volves
use of the autoanalyzer adapter for protein analysis by Dr. Summers
and Dr. Hill of the University of North Carolina.
Mr. Ben Eaton, Jr., Director of Administrative Services, presented a brief
review of Personnel and Budget for the fiscal years 1965-'67.
It was pointed out that the total State Appropriations for 1965-'67 is $9,664,-
728, or an increase of $1,331,271 over the prior biennium.
The combined total of State and Federal funds for the ensuing fiscal year
1965-'66 is $8,426,860, or an overall increase of $737,290. We do not yet have
the figures from some counties and cannot now indicate the Local appropria-tion,
which for fiscal year 1964-'65 was $8,026,994.
The major State increases for the current fiscal year over the prior year
1964-'65 are found in the ten percent general salary increase which amounts to
$168,231; for new personnel in the Laboratory $40,764; and for Hospital Care
NORTH CAROLINA BOARD OF HEALTH 23
(Cancer, Crippled Children, Maternal and Child Health), $128,951. An increase
of $32,424 was appropriated for Payments to Counties for the first year and
$64,848 for the second year.
In respect to personnel, thirteen additional employees were provided, nine
of which are for the Laboratory, three for Food and Lodging Sanitation, and one
for the Water Supply unit of the Sanitary Engineering Division. Within the
Laboratory, a new PKU Unit for the detection of errors of metabolism in infants
has been established which will utilize three of the employees provided for
this Division.
Mr. Eaton spoke of our additional budget requests for the biennium sub-mitted
to the Joint Appropriation Committee which totaled $2,801,701. This is
commonly known as "B" Budget and was primarily for additional employees
in nine programs, none of which was granted by the Legislature with the ex-ception
of $50,000 for Salt Marsh Mosquito Control. Priority Number One was
a request for $1,306,320 for the biennium for assistance to local health de-partments
to provide employment for much needed public health nurses and
sanitarians. This item of the "B" Budget Request after unfavorable action by
the Committee was revived during Legislative hearings, passed the Senate, but
was defeated in the House. Mr. Eaton stated that strong and effective lead-ership
was given to this request by local health directors. Dr. Norton, Dr.
Koomen, staff members, members of the Board, and others, and that a good
foundation was laid for further consideration by the Advisory Budget Commis-sion
and the next General Assembly.
Of particular concern is the tremendous decrease of Federal funds in the
General Health Grant. This amounted to $143,700 during the past two years.
The trend was first toward categorical grants with substantial decreases later
in this area and now a shift to special project grants. As a result, important
flexibility in our budget processes has been impaired and it presents serious
problems for the future in our budgeting procedures.
It was also noted that grants by the Children's Bureau were more than twice
the grants for the seven programs of Public Health Service which was $2,541,160
as against $1,153,174. There was an increase of $229,727 for the current year in
the two programs of the Children's Bureau, which are Crippled Children and
Maternal and Child Health; whereas, in the Public Health Service programs,
there was an overall increase of only $10,800, reflecting also the very large
decrease in the General Health Grant, heretofore indicated.
President Baker announced that it had been recommended by the Nursing
Home Section of the Board of Health that two new members be appointed by
the Board to serve a 3-year term on the Nursing Home Advisory Council. For
these appointments, Mrs. Edith Chance, Fayetteville, representing the North
Carolina Association of Nursing Homes, and Jere Roe, D.D.S., member of the
North Carolina Dental Society, had been considered.
It was moved by Mr. Lackey that Mrs. Edith Chance be appointed to the
Nursing Home Advisory Council by the Board of Health. The motion was sec-onded
by Dr. Dawsey, and carried. Dr. Cline moved that Dr. Jere Roe be ap-pointed
to the Nursing Home Advisory Council by the Board of Health. The
motion was seconded by Dr. Goodwin, and carried.
24 FORTY-FIRST BIENNIAL REPORT
Dr. Norton reported that Dr. John H. Hamilton was in the hospital for a
thorough check-up. It was moved that Secretary Norton write a note from the
Board expressing their best wishes for a speedy and complete recovery.
President Baker discussed informally Medicare which will be placed in a
State Agency designated by Governor Dan K. Moore. Dr. Norton stated that he
had indicated to the Governor that if placed in the Board of Health, we stood
ready and willing and would welcome the responsibility if it is the wish of the
Governor. Dr. Goodwin moved that the Executive Committee of the Board draw
up a statement to the Governor. The motion was seconded by Dr. Steiger, and
carried.
President Baker asked that the Executive Committee meet immediately
for a short conference following adjournment. At this meeting, the following
letter was drawn up, approved, and sent to Governor Moore:
"Dear Governor Moore:
The State Board of Health in regular quarterly session, August 26, 1965,
approved unanimously the following statement, drafted by its Executive Com-mittee,
on Title XVIII, Public Law 89-97 ("Medicare").
The official Board and Staff of the State Board of Health stand willing,
ready, able and, if the Governor wishes, would welcome designation of the
State Board of Health by the Governor as the Agency responsible for activities
in health protection and promotion, assuring quality preventive and treat-ment
services, and economical operation of Title XVIII, Public Law 89-97
("Medicare"), as it affects this State.'
Respectfully submitted,
J. W. R. Norton, M.D.,
State Health Director
There being no further business, it was moved and seconded that the meet-ing
adjourn.
Note: The State Medical Society Executive Committee meeting also on August
26, 1965, at Duke University, voted unanimously to recommend to Gover-nor
Moore that he designate the State Board of Health as the Agency to
carry out the provisions of Title XVIII. On August 31, 1965, Governor
Moore designated the State Board of Health to fulfill the provisions of
Title XVIII.
December 2, 1965
The regular quarterly meeting of the N. C. State Board of Health was held
Thursday, December 2, 1965, 1:00 p.m.-4:00 p.m., in the Board Room of the
Cooper Memorial Health Building, President Lenox D. Baker, M.D., presiding.
The invocation was given by Dr. Oscar S. Goodwin.
All Board members were present:
Dr. Lenox D. Baker Dr. A. P. Cline, Sr.
Dr. James S. Paper Dr. Joseph S. Hiatt, Jr.
Dr. Ben W. Dawsey Mr. J. M. Lackey
Mr. Samuel G. Koonce Dr. Howard P. Steiger
Dr. Oscar S. Goodwin
NORTH CAROLINA BOARD OF HEALTH 25
In addition to the Board members, there were a number of staff directors
and their assistants present, and each introduced himself and gave a brief
outline of his duties and responsibilities.
On motion duly made and seconded, the Minutes of the August 26, 1965
meeting were approved as circulated.
Mr. J. M. Jarrett, Director of the Division of Sanitary Engineering, presented
a proposed request for the Creation of the Maggie Valley Sanitary District in
Haywood County, North Carolina. He stated that all documents and transactions
had been examined and approved, and were found to be in accordance with
the General Statutes of North Carolina; and, therefore, the Sanitary Engineering
Division recommends that the Creation of the Maggie Valley Sanitary District,
Haywood County, be approved. Upon motion of Dr. Raper, seconded by Mr.
Lackey, the request for the CREATION OF THE MAGGIE VALLEY SANITARY
DISTRICT, HAYWOOD COUNTY, was approved.
Mr. Jarrett also discussed a request for the creation of the Cliffside Sani-tary
District. He stated that the Division was of the opinion that a sanitary
district would improve the sanitary conditions in the area and provide an ade-quate
water supply and sewage treatment facilities. All documents and trans-actions
have been thoroughly investigated by the Sanitary Engineering Division,
and found to be satisfactory, and in accordance with the provisions of the
General Statutes of North Carolina as amended by the 1965 General Assembly.
In view of this, he recommended to the Board that the Cliffside Sanitary
District be created as requested. On motion of Dr. Dawsey, seconded by Dr.
Goodwin, the CREATION OF THE CLIFFSIDE SANITARY DISTRICT, RUTHER-FORD
COUNTY, NORTH CAROLINA, was approved.
Then Mr. Jarrett discussed the criteria for marine toilets which were
adopted by the State Board of Health at its regular meeting in Raleigh on
January 9, 1964. These criteria were established at the request of the U. S.
Army Corps of Engineers and applied to John H. Kerr Reservoir and W. Kerr
Scott Reservoir. Mr. Jarrett recommended to the Board that these criteria
be repealed. On motion of Dr. Raper, seconded by Mr. Lackey, the criteria
for marine toilets adopted on January 9, 1964, were repealed.
For the purpose of carrying out the provisions of Chapter 75A-6 of the
General Statutes as amended by the 1965 General Assembly, Mr. Jarrett pre-sented
revised standards for the approval of sewage treatment devices and
holding tanks for marine toilets to be installed in vessels operating on the
inland lake waters of the State. These rules were discussed and on motion
of Dr. Raper, seconded by Dr. Dawsey, the recommended DESIGN STANDARDS
FOR MARINE SEWAGE TREATMENT SERVICES and HOLDING TANKS, were
adopted. (Copy filed with Minutes)
Dr. W. Burns Jones, Director of the Local Health Division, gave a brief
report on Home Health Services, for information.
Dr. James F. Donnelly, Director of the Personal Health Division, gave a re-port
on the present status of the PKU Screening Program. He stated that the
pilot program for PKU screening has been completed and that it appears from
26 FORTY-FIRST BIENNIAL REPORT
the data compiled so far that the method will be highly selective within a
day or two after birth, so that the screening program can be carried out while
the newborns are still in the hospital. The program will be available Statewide
beginning January 1, 1966.
Also, Dr. Donnelly reported that the expansion of Crippled Childrens' pro-gram
which now supports orthopedic disorders, congenital malformation, burns,
speech and hearing problems, rheumatic heart disease, convulsive disorders,
and cystic fibrosis is expanding its services to include support for asthma and
diabetes. This has been made possible by an increase in federal funds for
crippled children's services of approximately half a million dollars.
President Baker explained the recent publicity in the Durham Herald, read
the headlines, and quoted from the newspaper articles. Don Kellum, a reporter
for the Durham Herald held a news conference with Dr. George 0. Moore in
which Dr. Moore was quoted as labeling the medical group as a hard group
for the State Board of Health to work with. President Baker and Dr. Norton
both called Mr. Kellum. The next morning the headlines, again on the front
page were "NORTON AND BAKER ISSUE REBUTTAL . . ." President Baker
then set up a conference with Dr. Moore, Dr. Norton and the reporter in his
office. Dr. Moore retracted everything in the interview and President Baker
gave the reporter some of the background of the State Board of Health, in-cluding
the fact that it is a child of the Medical Society of the State of North
Carolina. The next morning there was a very short statement which President
Baker also looked up the word "discipline" in the dictionary (with reference
to his remarks concerning disciplining the physicians under the Medicare
program) and read several definitions of discipline and stated that the one
most applicable was "body of laws or practices which may be altered to meet
changing conditions, distinguished from nature and divine laws."
President Baker informed the Board that that morning there was a meeting of
the Executive Committee of the Medical Society of the State of North Carolina,
the State Hospital Association and the State Board of Health, and their Execu-tive
Secretaries. They came out with a motion to the effect that "we were re-questing
the Medical Society of the State of North Carolina and the State Hos-pital
Association to work out some guidelines of instructions, recommendations
and disciplinary lines to the members of the medical profession and to
the hospitals and to the members of the Board of Trustees of the hospitals
as to how these along with the State Board of Health could best implement
Medicare in this State, and that after they had reached this conclusion or
recommendation that it would come back to this Board for our consideration of
approval, and with that in mind one of them or both write one letter and sign
it, to the effect that they had recommended to the State Board of Health the
following things with regard to the utilization review committees on who should
be hospitalized and how the reports should come in. We had full cooperation
of the group attending this morning meeting."
Dr. Goodwin moved that the Board approve the action of the group which
met just prior to the Board meeting, and Dr. Cline seconded. Passed.
Dr. Jacob Koomen, Jr., Assistant State Health Director, discussed briefly
the Appalachian Regional Commission's role in health. A twenty-five (25) mem-
NORTH CAROLINA BOARD OF HEALTH 27
ber Health Advisory Committee, Is In the process of establishing guidelines
for Implementation of the health related portions of the Act.
As Information to the Board, Mr. Ben Eaton, Jr., Director of Administrative
Services, reported on the untimely death of Mr. Walter Croy, Assistant Budget
Officer, which occurred on October 19, 1965. Mr. Eaton spoke of the Invaluable
service that Mr. Croy had rendered and referred to him as a very able and
fine gentleman.
Mr. Eaton also reported briefly on the budgetary progress of the new pro-gram
entitled "Home Health Services" which was discussed earlier by Dr. W.
Burns Jones. He stated that the State matching requirements for this new
program Is one dollar ($1.00) for each ten dollars ($10.00) provided by the Fed-eral
Government which is on an exceptionally favorable basis. The State will
be required to provide approximately $20,800 for this new program which, at
this time, we are seeking to arrange within the overall budget of the Depart-ment.
Mr. Eaton suggested to the Board that each member may wish to review
his copy of the proposed Agreement between the Department of Health, Edu-cation,
and Welfare, and the State Board of Health concerning the administra-tion
of the Medicare Program. This proposal which has not been executed,
outlines the major responsibilities of the State Board In dealing with this
program.
As information for the Board, Dr. Norton gave brief verbal reports on the
following items of interest:
(a) Signing of the Medicare Agreement ceremony to be held in the Gover-nor's
Office at 11:15 a.m. Monday, December 6, 1965.
(b) Conference to be held on December 15, 1965, with representatives from
the Social Security personnel regarding Medicare, budget, personnel, etc.
(c) Meeting in Pinehurst for orientation, etc. on Medicare January 27-30,
1966.
On motion duly made and seconded, the Board meeting adjourned.
SPECIAL SESSION
December 2, 1965
In a special session of the Board held on December 2, 1965, North Carolina
State Health Director, Dr. J. W. R. Norton submitted his resignation. He asked
that the resignation, submitted because of health reasons, be made effective
December 31, 1965. As requested by the Board, Dr. Norton agreed to assume a
position In the State Board of Health other than that of State Health Director
or Assistant State Health Director. The Board and the Board of Health ex-pressed
regrets over Dr. Norton's resignation, and appreciation for his services
as Director during the past seventeen and a half years. Dr. Norton's letter
of resignation Is filed with the official Minutes.
After discussion, the Board, subject to the approval of the Governor, took
the following action: (1) Named Dr. Jacob Koomen Acting State Health Director
28 FORTY-FIRST BIENNIAL REPORT
and Secretary-Treasurer for the remainder of Dr. Norton's appointment; (2)
Named Dr. W. Burns Jones, Jr. Acting Assistant State Health Director for the
remainder of Dr. Koomen's appointment.
President Baker, Dr. Cline and Dr. Norton conferred with Governor Dan K.
Moore concerning the above recommendations to the Board. Governor Moore
gave his approval to the action of the Board.
Dr. Koomen v^^as sworn into office at noon Tuesday, January 4, 1966, in the
John H. Hamilton Auditorium of the Laboratory Division of the State Board
of Health. Dr. Lenox D. Baker presided. Governor Dan K. Moore expressed
appreciation for Dr. J. W. R. Norton's long service and confidence in Dr. Koo-men's
leadership for the future. North Carolina Supreme Court Justice Susie
Sharp administered the oath of office.
May 4, 1966
The North Carolina State Board of Health met in conjunction with the an-nual
session of the Medical Society of the State of North Carolina in the
Grove Room, Battery Park Hotel, Asheville, Wednesday, May 4, 1966, 8:00 a.m.
to 8:30 a.m. Dr. Lenox D. Baker, President of the Board, presided.
Attending: Lenox D. Baker, M.D.
James S. Paper, M.D.
Ben W. Dawsey, D.V.M.
Oscar S. Goodwin, M.D.
A. P. Cline, Sr., D.D.S.
Joseph S. Hiatt, Jr., M.D.
J. M. Lackey
Howard P. Steiger, M.D.
Absent: Samuel G. Koonce, Ph.G.
In addition to the Board Members, staff members present included: Dr.
Jacob Koomen; Dr. W. Burns Jones, Jr.; Mr. J. M. Jarrett; Dr. Edwin S. Preston;
Dr. William A. Smith; Mr. W. Gordon Poole; and Mrs. Doris P. Sitterson.
Dr. Baker pronounced the invocation. The Board approved the minutes of
the Board Meeting held December 2, 1965, as circulated.
Dr. Koomen gave a brief report on the activities of the Board of Health
during the past four months. Board Members expressed approval of the new
procedure of receiving periodic letters from Dr. Koomen describing State
Board of Health activities instead of the bulky mimeographed Reports of the
past. Dr. Koomen reported on the preparation of the "A" Budget, which is now
completed; and the "B" Budget which is being compiled. Dr. Koomen stated
that we are hard at work on the implementation of Medicare. North Carolina
is well ahead of most of its neighboring states.
Dr. Koomen reported to the Board his action in appointing Dr. Lynn Maddry
as Director of the Laboratory Division of the State Board. Mrs. Corrina Sutton
will serve as Acting Assistant Director of the Laboratory. Miss Elizabeth S.
Holley, formerly on the staff of the School of Public Health, UNC, has been
NORTH CAROLINA BOARD OF HEALTH 29
named Chief of Public Health Nursing Section. Dr. William A. Robie has ac-cepted
the position as Chief of the Heart, Cancer and Chronic Disease Section,
within the Personal Health Division.
Dr. Koomen expressed his appreciation to the Board for all the help the>
have given him and the other members of the staff.
Mr. Jarrett, Director of the Sanitary Engineering Division, presented, for the
approval of the Board, a request for the extension of the Rural Hall Sanitary
District In Forsyth County, North Carolina. He stated that his office had
examined the documents, including an original petition from the residents, and
that they were in compliance with the statutes as required by law. Mr. Jarrett
therefore recommended approval of the request for this extension of the Rural
Hall Sanitary District. Dr. Raper moved THAT THE STATE BOARD OF HEALTH
APPROVE THE REQUEST FOR THE EXTENSION OF THE BOUNDARIES OF
THE RURAL HALL SANITARY DISTRICT IN FORSYTH COUNTY, NORTH CARO-LINA.
The motion was seconded by Mr. Lackey and passed.
For his second presentation, Mr. Jarrett stated that his office had received
a request for the extension of the Yanceyville Sanitary District. He further
stated that all documents and transactions had been examined and approved,
and were found to be in accordance with the General Statutes of North Caro-lina;
and therefore, the Sanitary Engineering Division recommends approval
of the extension of the Yanceyville Sanitary District. A motion by Dr. Steiger
THAT THE STATE BOARD OF HEALTH APPROVE THE REQUEST FOR THE
EXTENSION OF THE BOUNDARIES OF THE YANCEYVILLE SANITARY DIS-TRICT
IN CASWELL COUNTY, NORTH CAROLINA, was seconded by Dr. Raper
and carried.
Mr. Jarrett brought before the Board for their approval a list of acceptable
marine toilets. For detailed explanation, see materials in official files. Dr.
Goodwin moved THAT THE STATE BOARD OF HEALTH APPROVE THE LIST
OF ACCEPTABLE MARINE TOILETS AS PRESENTED. Dr. Raper seconded the
motion and it was passed.
There being no further business to come before the Board, the meeting
was adjourned.
In a brief Executive Session following the General Board meeting. Dr. Jacob
Koomen was officially elected as State Health Director, Dr. W. Burns Jones
was elected Assistant State Health Director. Both elections were to become
effective upon approval by Governor Dan K. Moore. The Governor's approval was
secured by phone by Dr. Baker on this same date.
30 FORTY-FIRST BIENNIAL REPORT
CONJOINT SESSION
CAN "MEDICINE" OVERCOME TECHNOLOGICAL CIVILIZATION?
May 5, 1965—Address by William L Wilson, M.D.
Chief, Occupational Health Section, North Carolina State Board of Health.
"Not only in antiquity, but in our own times also laws have
been passed in well-ordered cities to secure good conditions for
the workers; so it is only right that the art of medicine should con-tribute
its portion for the benefit and relief of those for whom the
law has shown such foresight; indeed we ought to show peculiar
zeal, though so far we have neglected to do so, in taking precau-tions
for their safety, so that as far as possible they may work at
their chosen calling without loss of health".—Ramazzini
Two and a half centuries ago Ramazzini, the father of occupational health,
challenged "medicine" thus. Our neglect persists. Hence, it is appropriate
at this time to devote attention to this subject. A State Board of Health occu-pational
health study of some circumstances which affect our citizens' indus-tries,
property, health and lives, required by statute, recently has identified
these matters in this State.
To "show peculiar zeal" we must start with uniform terms. Members of
this Society and the North Carolina Governor's Council on Occupational Health
have agreed upon "occupational health" as the adequate protection and main-tenance
of the physical and mental health of every working person in order
to permit useful, productive work as he continues emotionally and psycho-logically
suited to his job.' An employee's health can be evaluated only by a
physician, practicing modern occupational medicine. "Industrial hygiene",
requiring scientific procedures of industrial hygiene surveys, recognizes, iden-tifies
and evaluates the work environments' factors which may or do cause
diseases in employees who would not be ill if not so exposed because of
their work.
Occupational health protects employees' personal health only when hazards
in their work environments are controlled. Such control differs from that used
against communicable diseases, chronic diseases, accidents, and other health
problems, because it is subject legally to so many third party controls of
differing legal, economic, and other origins. The third party is the employer,
legally charged with controlling the work environment.
The "productive population" comprises all adults employed in every gain-ful
manner, wherever they may be. Lack of occupational health jeopardizes
not only one individual of this productive population, but co-workers, and
the whole 2/3 non-productive population, hence the whole community. Thus,
the economic, educational, health, social and sociological status of the whole
community, their improvement or retrogression, is at stake.
Occupational health succeeds only after effectively applying preventive
medicine's industrial hygiene to work environments, and its occupational medi-cine
to its working persons. When preventions fail additional clinical medicine
must be provided on the job, but even more off the job, at the inevitably
NORTH CAROLINA BOARD OF HEALTH 31
increasing costs of therapeutic medicine, hospitalization, and rehabilitation.
Other detrimental community losses are mounting costs of compensation, sick-ness
or disability and other insurance benefits, and even death benefits. All
of these essential but scarcely amending gestures forecast consequent future
reductions in health protection.
Current technology compels expanding medical understanding of the chem-ical,
physical, and biological factors, eternally changing in our environments,
whose continually changing hazards can cause diseases acquired from air,
water, earth, foods, and the many work environs which must benefit and serve
us. Our employers pay many persons to engage in those public health programs
and preventive medical practices designed and known to protect the produc-tive
population from occupational diseases. However, they and all others con-trolling
community health resources, with medical guidance, also must engage
helpfully in the practices of preventive medicine. Occupational health, there-fore,
is an outstanding example of a community's pre-set "survival" stand for
private enterprise.
Occupational injury and disease, legally defined as well as defined by us
medically, may be relatively harmless, but they may cause disability. Dis-ability
also is defined both medically and legally. Regardless of how consistent
and beneficial these definitions may be, disability reduces or stops normally
gainful, productive work. Therefore, we must answer for unjustified medical
failures to prevent disability.
The nature of an occupational disease deserves special attention: its demon-strated
personal job exposure to the causative agent, with the known degree
and time required for personal response; its typical clinical effects known to
come from this agent; its lack of identification as something else; its pre-viously
proven capability of producing this response in man. Characteristically,
removal from exposure usually results in improvement. The personal effects
of occupational diseases are measurable; they can be evaluated, but only
by a physician.
Our 30-year old occupational disease program applied to a very few North
Carolina work places does protect the health of only a few employees.
Yet, our progress for over three centuries has depended upon the health of
the whole productive population, clearly limited by extent of their production,
income, purchase of goods and services, beneficial taxation, and most simply,
their votes. Hence, political attention is given increasingly to "medicine". We
may well ponder Disraeli's 1877 advice that "The health of the people is really
the foundation upon which all their powers as a State depend."
If you examine Table 1 filed with this report, you will find reflected numer-ous
Federal and 32 State Board of Health statutory responsibilities, grouped
administratively into three scientifically separate programs: (19 tables and 5
figures are available upon request in a supplement to this report.)
The oldest for 30 years has demanded industrial hygiene study of occupa-tional
diseases and direct diagnostic services to the North Carolina Industrial
Commission. This is a vital program which must continue even though too
late to protect any productive population's health. It is the only program we
can show significantly implemented to date.
32 FORTY-FIRST BIENNIAL REPORT
A second (eight years old) program requires preventive studies of job-cre-ated
(occupational) health hazards so as to eliminate or reduce them. Adequate
means have never been established for more than merely token compliance.
A third (six years old) program ostensibly protects the present and future
population effectively against somatic and genetic effects of ionizing radia-tion
exposures. However, the Board's authority to undertake this with respect
to 4/5 of all public radiation exposures was removed by a 1963 legislative
amendment even before the 1959 Act could be implemented by the Board,
or by any other agency.
Statutory priorities have limited industrial hygiene studies to 300 "dusty
trades" with some 7,000 employess only. This continually leaves only 1/5 of
our capabilities available for all remaining employers and 1.7 million em-ployees.
Must we have a crisis to improve this situation? Unfortunately in
previous public health needs the answer too frequently has been "yes". Yet,
Rene' Dubos has inquired two and a half centuries after Ramazzini, "Is it not
the responsibility of medicine to be concerned with the problems posed by
the long-range responses that the body and the mind make to the new threats
created by technological civilization?"
Does not medicine's long-range concern call first for measurements of
where we are now? Military occupational health failures long have been evalu-ated
by the status of "daily non-effectiveness". Every command applies the
standardized "non-effective rate", a general measure of the prevalence of all
disease and injury causing "excuse from duty status". The Army daily average
non-effectiveness is about one percent. Our own comparable civilian non-effectivness
probably is between three and five percent. To counteract non-effectiveness,
now and long-range, occupational health compels "medicine" to
do positive professional things about the socio-economic factors involved, and
employers to heed the medical and health significance of their work environ-ments,
and their own workers' personal health conditions.
To summarize to this point, then, our studies indicate we must evaluate
the whole population involved, the productive population, all health risks faced
at work, industrial hygiene controls of those risks, the effectiveness of occupa-tional
medicine for the productive population, and the whole community or
public health. All of these measure the community non-effectiveness, the
opposite of which is effectiveness. Occupational health is effectiveness.
Almost 2/3 of our whole population still live "rural". Our median age is
four years under the Nation's, yet life expectancy has increased nearly 16 years
since 1920. All of this controls our current "productive population", with
changing birth rates, with increase of those over 65, and with increasing female
to male ratio over 65.
The "productive population" must produce the future generations, educate
and serve present and later generations; maintain community continuity by
government; guide the future; and "research" the changes, the improvements,
and the increased productions, required.
At the turn of the century while the United States productive population
was 57 percent of the whole, small families assured that by 1940 it would be
NORTH CAROLINA BOARD OF HEALTH 33
near 65 percent. North Carolina's productive population today is some 61 per-cent,
the United States just over 50 percent. Thus, controlling factors for
Dubos' "technological civilization" have been our productive population's ages,
variable birth rates, mobility, urbanization, industrialization, mechanization,
automation.
Our agricultural workers comprise under 1/4 of the 1.7 million employed.
Our total non-agricultural employment, and our manufacturing employment,
have been increasing about 3 percent per year. Recent data show over 42 per-cent
of our non-agricultural employment now is in manufacturing.
In this framework agriculture, industry, and medicine are changing, are
ever more complex, and must adapt to the very rapidly increasing work en-vironmental
hazards to our people. North Carolina measurement of these
hazards, and the provision of control measures, are not increasing appreciably.
These circumstances assure disadvantages to all of us.
How can North Carolina afford economically not to protect and maintain
the health of its all-important productive population? With our manufacturing
and farm workers' earnings already considerably below national averages,
interruption reduces the family funds required to protect the entire family
health. Family medical care costs have risen; the total community economy,
unfortunately, has been reduced. The increased costs apply to every com-munity
interest.
For the costs of disability recall North Carolina's share of acute health
conditions at some 10 million persons in 1963. In 1961 every person 17 and
over averaged 5.4 work loss days. Our people have their share of the 74 mil-lions
having also one or more chronic diseases. The older the person over 44
years, the greater is the incidence. Our State Health Plan five years ago added
occupational health objectives clearly defining for the first time this matter,
and listed actions hopefully to benefit our aging productive population with
their increasing chronic illnesses.
The family outlay recently for personal health services to meet all these
acute and chronic family health problems is about five percent of their in-come.
Yet, the total expenditures for health and medical care showed a 24
percent increase from 1940 to 1960. What was purchased? The medical care
price index more than doubled between 1940 and 1961.^ The result? In North
Carolina, farm families have used less than half the treatment services they
needed; of the necessarily small amounts they spent for health, less than 4
percent has gone for diagnostic and preventive services. We don't even have
similar non-farm family expenditures data.
So much for the employee costs. What about the resultant increased costs
to our vulnerable North Carolina employer, for example on absenteeism, com-pensation
and medical care costs, production lags, reduced production, and
the costs of replacement of lost personnel? Personnel studies have revealed
the average cost of replacing an employee at $3,000!' Thus, every employee
kept healthy and on the job, selfishly, means more dollars to all of us.
No segment of our population has had its health so patently and generally
neglected as our 61 percent working adult age group. The remaining 39 per-
34 FORTY-FIRST BIENNIAL REPORT
cent have had gratifying attention. Very few of our working people have occu-pational
health programs.-* When or how else, can they possess health?
Table 2 of the supplement shows the likely distribution of the average
employee's weekly 168 hours. Then, Figure 1 shows why the only channels
"medicine" can keep open to this productive population in promoting their
health exists during their "8 to 5" work hours. Medical practice, hospitaliza-tion,
and health department services, are all available only these same hours,
except for true emergency to protect, maintain, or restore their health, or
rehabilitate them to effective productive capabilities.
Four years ago, the Vice President, North Carolina State Board of Health,
wrote several pertinent statements on this matter, of community responsibility
to the employer, of State Board of Health responsibilities. Doctor John R.
Bender, himself in practice, went on to state: ". . . this does not minimize the
obligation of the individual practitioner. Practicing physicians must also pro-vide
advice and local leadership for employers." The more a State Board of
Health may participate effectively in promoting occupational health, Doctor
Bender wrote, ". . . the more professionally gratifying and compensable will
be the private practice of medicine and the furnishing of health services by
practicing physicians."*
Is It not time now for "medicine" to examine itself? In 1962 only about
one percent of all United States medical specialists practiced occupational
medicine.* We find that the known full- and part-time North Carolina occu-pational
medical practices serve less than one percent of our productive
population. This is compatible with our latest Society Roster of Members
(December, 1964) where one can identify 68 "PH" (public health) physicians,
but only 17 "Ind" (industrial practice) and 7 "Ins" (insurance practice). All
of us know that, few as they are, more than 24 North Carolina physicians
engage in occupational medical practice. Why then, if not consciously con-cealing,
would our colleagues at the same time not openly declare their occu-pational
practices available?
To stabilize this occupational medicine itself, with pre-planned health
department and medical society supports, needs immediately to correct uni-versal
misconceptions of the medical practice and health departments by an
aggressive, factual, impressive educational program; help all physicians to
know complex ecological effects of changes occuring in agriculture, industry,
and medicine, so they can interrelate and apply to these changes their "know-how"
in preventive medicine; prove that what has been done up to now by
occupational health has been medically effective, rewarding, professionally
gratifying, and has improved some of our communities socio-economically;
convince physicians that compensation practice may be modestly remunera-tive,
but cannot benefit physicians, the victim, or the community equitably
when the disease or injury should have been prevented medically; persuade
more physicians and health departments to furnish aggressively those pre-ventive
services long ago over-due to their own people.
Irrefutable statement of some facts and candidly driving them home fear-lessly
to all of our colleagues is required. None can succeed alone. Health
departments must furnish clear concepts of the current health status, spot-
NORTH CAROLINA BOARD OF HEALTH 35
light lessons of the past, and periodically recommend the rapidly effective
and feasible undertaking by all of us for the future. While the remainder
of this report summarizes and places examples sharply in focus, only this
Society and the State Board of Health may determine jointly a future course
of effective responses. Come alive then—we are in the productive population
generation!
How can our society measure the North Carolina record? We have exam-ined
the causes of deaths, their numbers and rates, as heart, malignancy,
central nervous system vascular lesions, accidents, pneumonias. They do not
correlate with occupational disease incidents. We have given attention to
diminishing communicable and other diseases, to increasing traffic accidents,
to the numerous other but more adequate health programs. Yet, who can
remember one recent publication about increasing costs or medical implica-tions
of North Carolina occupational injury and illness of non-compensable
nature, or the workmen's compensation cases, as deaths or case incidence?
Infectious diseases will be here always, as a matter of changing biological
balances, between man and other organisms as well as the rest of the bio-chemico-
physical environment. But just think—during all of 1964 all of our
2,200 cases of those communicable diseases earning close watch" were only
1/4 as many as we averaged for occupational injury and illness reported to
our Industrial Commission every month; in 1964 there were only 1/4 as many
of all of these as there were cases of working people who proved compensable
under the Workmen's Compensation Act; less than 1/20 as many of these as
were injured in traffic (1581 killed, 49,124 injured in 1964).
To question further our imbalance in measuring health significance, keep
in mind that these traffic victims seldom elicit the sensational attention given
to just one serious injury or death due to a rare radiation accident. Similarly,
the 1964 occupational health problems, considerably out-numbering traffic and
significant communicable disease cases combined, are ignored.
Why does "medicine" not determine medically why our people have job-caused
injury or illness? Or why do people have nonjob-caused disabling
illness and injury? How will valid answers benefit our productive population,
our economic production, the individual employer or employee, their health,
their personal physicians? How shall we relate our answers to ever-changing
balances between work environment factors and individual personal factors
of the individual employee, and then provide Bender's "local leadership" to
protect his health? When Doctor John W. Morris reported last year in our own
Medical Journal on the 1962 Workmen's Compensation Act medical payments
of $25,000 daily,' who reported how much was because preventive medicine
and occupational health were "missing in action"? There were active accident
prevention programs. But both always will be necessary. How much did local
managements, physicians, and health departments use information furnished
to them about existing or new industries, or about State or local health depart-ment
services available to their own employees?
In 1964 there were nearly 99,000 on-the-job injuries and illnesses, and not
all are reflected. One hundred seventy-nine "fatal injuries" reported to our
Industrial Commission were due predominantly to falls, motor vehicles, and
36 FORTY-FIRST BIENNIAL REPORT
electrocution, but to "heart" with ever-increasing regularity. How many deaths
or cases were due to heart, other physical conditions of the employee, which
could have been medically predicted, diagnosed, averted, controlled, treated,
or otherwise neutralized?
Mere case incidence does not tell the sole management story nearly so
much as the differing rates of incidence for certain populations at risk in cer-tain
types of industry or with total costs to certain employers in these same
and other employee groups. Return to "heart" reports, then recall that 50
times more deaths in industry likely have occurred due to heart disease than
to industrial accidents.' Why shouldn't all result in "occupational disease"
compensation claims? Awards for such are increasing! No one can say what
or how much the occupations in our "technological civilization" have had to
do with this increasing heart, diabetes, arthritis, emphysema, other chronic
pulmonary disease, or cancer, morbidity. How can our State have economic
health with vacuous medical guidance?
Is the answer simple? Should not every employee have his personal health
status established clearly by a physician's pre-employment examination? When
justified, he should have special examination thereafter. Despite debated
value of periodic examinations, how else can later personal health status be
known? This is particularly significant because we have in prospect increasing
chronic diseases and aging population, and a larger proportionate productive
population.
Table 3 of the supplement shows you why four fifths of all State Board of
Health industrial hygiene studies required by statute serve less than one
hundredth of one percent of the non-agricultural employees in this State.
Successes of the remainder worth your attention are shown in Table 4 of the
supplement. If we could be ready, our new Research Triangle's Environmental
Health Center and the University of North Carolina million-dollar Institute of
Environmental Health Studies would support extensively our State's occupa-tional
health. But, we aren't ready.
Table 5 of the supplement summarizes data recently developed for the
Governor of Pennsylvania, who sponsored a conference on occupational pneu-moconiosis
in late 1964. Pennsylvania's death rate had been more than eight
times that of the whole United States for that disease, with over half of all
such deaths in this country in 1960. At Pennsylvania invitation Canadian,
British, and our North Carolina experience' were reported. The conference
concluded Pennsylvania cannot meet its responsibility merely by furnishing
diagnosis, treatment, compensation and insurance payments, to their pneu-moconiotics.
North Carolina employers know that we reported significant economics.
Four fifths of all compensation they had paid for preventable occupational
diseases had gone for pneumoconioses. However, less than 1/10 of the much
greater pertinent medical costs went to pay for medical treatment of these
two diseases. This means that over 9/10 of North Carolina millions paid out
for medical treatment of job-created injuries and illnesses has been due to
generally preventable circumstances which are receiving sparsely effective pre-ventive
medicine or occupational health attention. Table 6 shows our average
NORTH CAROLINA BOARD OF HEALTH 37
annual compensation and medical costs 1936 to 1940 were 1.6 million dollars
for over 40,000 people forced off the job by occupational injury and illness
every year. The annual compensation and medical costs for over 85,000 people
during each of the latest five years averaged 15.5 million dollars. Costs soared
at far greater rates than did any other measurable factor. How unjustifiably
is North Carolina now wasting its manpower, its health, therefore its produc-tivity,
its property, its economy, its lives? Some economic and social implica-tions
of these facts, which "medicine" should examine, follow.
As total cases have doubled, the compensation trebled, but medical costs
for the compensated employees went up five times. Where cases received no
workmen's compensation the medical costs only trebled! What consolation is
found in this? Even more unflattering medically, during each of the past five
years of modern "medicine" 85,000 employees have averaged 1/3 more days
lost per case per year than half that many experienced at the start of this
program 30 years ago. Recall, if you will, the income and health expenditure
data mentioned earlier. What advances can North Carolina "medicine" claim
here?
Our own State documentation proves that adequate occupational health
has given a few North Carolina employers opportunities to stay in equitable
competition with others. For example, the hazards of silicosis have been
reduced consistently by the cooperation given by some 300 "dusty trades"
employers. This 30-year program, required by law, has resulted in periodic
industrial surveys to protect employees from dust hazards of their work areas.
See Tables 7 and 8 of the supplement.
The law required also pre-employment and annual physical examinations
of all exposed employees, always with chest x-ray films, an estimated total
of 12,000 persons. Their results permit us to examine some socio-economic
effects of silicosis.
Table 1 showed six State agencies involved in this program, the State Board
of Health in the health aspects. Table 9 and Figure 2 of the supplement show
a few work environments selected at random where effective industrial hygiene
attention reveals markedly reduced silicosis health hazards. Figure 3 of the
supplement shows you that pre-employment and annual employee medical
examinations have reduced employee case incidence. These measures have
assured many more man-work years before silicosis was diagnosed. Due to
their longer employment, and older ages at diagnosis, greater retirement, social
security, and other benefits have accrued to these individual employees, their
families, and their communities, once diagnosed. We have demonstrated also
prospects of reduced workmen's compensation payments and medical care
costs, employees' replacement costs, and many expanded related benefits.
Figure 4 of the supplement shows all our silicosis diagnosed in the past
30 years. Nearly half exceeded the early or Grade I case in severity. Figure
5 of the supplement shows you that in the past five years only 1/4 have done
so, and in the past three years only 3 percent. By now a North Carolina dusty
trades employee has only 1/20 as much chance of a diagnosis of silicosis as
he had in 1935. There has been no case of silicosis diagnosed in North Caro-lina
during the past six months!
38 FORTY-FIRST BIENNIAL REPORT
We have identified the vulnerable employees, the hazards, and the cases.
We have ended harmful exposures of cases. We have progressed towards elim-ination
of silicosis, and added inevitable beneficial byproducts. For example,
Table 10 shows an annual average of 42 employees during the past five years
who learned of other previously undiagnosed serious pathology, predominantly
cardiac, and were referred promptly to their physicians for treatment. Table 11
shows we are examining the expanding problem of pulmonary emphysema.
See Tables 12 to 19 of the supplement for Examples "A" and "B" selected
from our records. These two firms summarize the pertinent points I have pre-sented.
Of course, exposure at different jobs within each firm, or between the
firms, have not at all been equally hazardous. With average age of the total
of 178 silicosis cases diagnosed the past ten years at 50, they were older for
the more severe cases. Consider "A", with average employment of about 300,
a plant where improved work environment has been evident, and "B" a firm
with average total employment about 70 where significant work environment
improvement has not been discernible. Very few of "A's" 46 cases had under
10 years exposure, 4/5 had more than 20 years. "B's" 37 cases showed clearly
the opposite. In the latest 10 years diagnosed "A" employees have averaged
21.5 years older than "B" employees. "A" profitted more than "B", by medical
examination and other measures, so that far fewer "A" cases had had prior
employment exposure than "B". "A" cases with prior employment exposure
had more than twice as long exposure during "A" employment as did similar
"B" cases during "B" employment. "A" profitted more than "B" in screening
applicants also with no prior employment exposure. Such "A" employees had
more than double the years of exposure, at times of initial diagnoses.
As a result of our study we know that identifiable worth-while preventive
measures have caused at least one serious, expensive, occupational disease
in North Carolina to be disappearing; this is because the likely serious hazards
of the specific work environment, and the risks of damaging individual em-ployees'
health, have been anticipated and measured by the employer wishing
to protect his individual employees' health, not true where an employer is not
so doing. To present one or more exceptions cannot impressively rebut the
facts. We have distinguishing honors to add to these factual achievements.
North Carolina "medicine" should be proud that since our last meeting our
fifth industrial medical program, Hanes Hosiery Mills Company, has been
awarded the prized Occupational Health Institute's Certificate of Health Main-tenance.
A month ago this same Company, through Mr. Gordon Hanes, Presi-dent,
received the Industrial Medical Association's 1965 Health Achievement
in Industry Award. This is only the second southeastern (1955), but the first
textile, and the first North Carolina industry, program ever to receive this
Award since its origin in 1949.
Dubos' "medicine" is not failing North Carolina's "technological civiliza-tion"
because we are scientifically or quantitatively lacking. We are failing,
however, and far more than justified. Where we fail, is it not because North
Carolina "medicine" does not sufficiently "show peculiar zeal" Ramazzini iden-tified
long ago as so necessary, ". . . in taking precautions for their safety,
so that as far as possible they may work at their chosen calling without loss
of health"?
NORTH CAROLINA BOARD OF HEALTH 39
There is hope. All but 420 of us in only 17 local medical societies have
ready-made channels for "zeal"; namely, our State Society's Committee on
Occupational Health and the 58 local Society Committees on Occupational
Health, all with designated and published chairmen. Yet, why does only one
local two-county society of over 350 members have no designated chairman,
when never before have we had so many local chairmen serving so many as
we do this year?
The State needs both expanded occupational programs and more industrial
hygiene services. What prospect of failure has "medicine" if our State and
local committees will be our active agents, will recruit joint actions by their
own members and local employers, local health departments, and the State
Board of Health staff, in their support, and if "medicine" will lead the State
to increased preventive medical and industrial hygiene services? None, be-cause
even at this late date vigorous occupational health action by "medicine"
can assure North Carolina's competitive stature in this day of "survival" eco-nomics.
Let not Ramazzini have reason to haunt us!
REFERENCES
1. North Carolina Governor's Council on Occupational Health: "Better Occupational Health
for North Carolina," Raleigh, Published by the Council, 1960.
2. Goldfield, E. D.: "Statistical Abstract of the United States," 83rd Annual Edition, Wash-ington,
U. S. Government Printing Office, 1962, P.76 (Table No. 88); P.77 (Tables
No. 89 & 90); P.87 (Table No. 106); P.238 (Table No. 314).
3. Anon.: Heart Research Opens New Dimensions to Industry, "Occupational Hazards":
P.21-24 (Feb.) 1965.
4. Wilson, W. L.: Many Want Occupational Health, "Archives of Environmental Health":
3:7-8 (July) 1961.
5. Bender, J. R.: The "Forgotten Man" in Total Health; Influence of a State Board of Health,
"Archives of Environmental Health": 3:14-16 (July) 1961.
6. Wathen, F. P.: Physicians Specializing in Occupational Medicine, "Journal of Occupational
Medicine": 6:288-292 (July) 1964.
7. Nick Elliott: North Carolina Is Still Winning War Against 10 Deady Diseases, "The Raleigh
Times," P.I 5 (Feb. 8) 1965.
8. Morris, J. W.: Workmen's Compensation: Its Philosophy and Application, "North Carolina
Medical Journal"; 25:155-159 (April) 1964.
9. Wilson, W. L.: The North Carolina Pneumoconiosis Prevention Program in Dusty Trades,
read before Pennsylvania Governor's Conference on Pneumoconiosis, Harrisburg Penn-syvania,
November 30, 1964.
FORTY-FIRST BIENNIAL REPORT
CONJOINT SESSION
May 4, 1966—Address by Jacob Koomen, M.D., M.P.H., State Health Director
This is the time when we annually report on the stewardship entrusted by
the Society and the citizens of North Carolina to the State Board of Health.
I recall to you the fact that the State Board of Health is a nine member
body, four coming out of the Society and five appointees of the Governor.
Those from the Society are Dr. Goodwin, Dr. Raper, Dr. Hiatt and Dr. Steiger,
all well known to you for their achievements within the Society and outside of
it. The Governor's appointees are: Dr. Baker, whom you have just heard intro-duced
with the appropriate praise due his achievements; Dr. Dawsey who repre-sents
so well the veterinary profession; Dr. Cline, representing in like manner
the dental profession and Mr. Lackey who represents the dairy interests of
the state—all extremely important areas in the health field.
In presenting a brief accounting of what has been done, I should like to
mention first, that this year brought the retirement of Dr. J. W. R. Norton
as State Health Director after a period of nearly 18 years in this office—
a
period of phenomenal growth and phenomenal progress. He will be with the
State Board of Health in the future as Director of Local Health Services.
The year of course has been an exciting one. Because, perhaps at least
in my lifetime and yours as well, this is an era of great revolution in research,
in knowledge, and in all the fields of health that have to do with prevention,
with cure and with rehabilitation. Your Society, as reflected in those of us
who belong to it, as reflected in the citizens, as reflected in your responsibili-ties,
are all in this dynamic period of change and progress. Further than that,
we share the anxiety over the truly terrible shortage of manpower and we
look for ways of extending the arms of those already working.
The North Carolina State Board of Health is involved in some thirty pro-grams.
Many of these touch you frequently, some touch you each day. We have
been well supported by the Board and, we trust the reverse is true, that we
have supported them in like manner.
I should like now briefly to talk about the functions of the various Divi-sions,
hitting only the high spots. In discussing thirty programs, obviously it
is not possible to mention them all and we have in turn from year to year
talked about one function or another.
I should like to give you a general overview of what is going on in public
health in North Carolina.
First, I have to mention the matter of money. There is, of course, not enough
spent on health; there will be more in the future. North Carolina, as you know,
is the nth most populous state and one which expects to have 5,000,000 people
in September of this year. In the domain of direct public health our State spent
$19,600,000 during the last fiscal year. This represents an increase of better
than $3,000,000 over the year before.
NORTH CAROLINA BOARD OF HEALTH 41
Perhaps surprisingly, an increase of better than $800,000 came out of in-creased
appropriations by local bodies. Public health is very well supported
by the citizenry at the county level.
Our staff has grown, the State staff now stands at a level of 432 staff mem-bers
and the Local Health Departments have another 1,500 working close to
those they serve. North Carolina has one of the largest public health organiza-tions
in the Nation as suits its particular health needs. And, if I might say so
as an outsider, it also has the best.
We distribute, as you know, THE HEALTH BULLETIN, with a circulation of
47,000 per month.
We have a Public Health Library of our own and more than 8,000 visitors
were recorded there last year.
Our Film Library—known to all of you since you are frequent borrowers from
it, as are the colleges, the schools and the churches—had a circulation of
almost 43,000 films last year.
The recording of data in an organization such as ours leads to astronomical
numbers of pieces of literature, important ones like birth certificates and
death certificates, and all of our correspondence. Of these we had more than
277,000 pieces permanently recorded. And I might say that, lest you feel this
is an outgrowth of red tape in North Carolina government, it is not. North
Carolina government is a superbly efficient, smooth-running government; vir-tually
devoid of the sort of criticism, perhaps I should say devoid of this sort
of criticism, which one so often thinks of in the sort of American humor that
has to do with red tape. Our governmental system is efficient and simple and
there is no red tape, in my estimation.
In the matter of publications we supply to the citizens, we publish not
only THE HEALTH BULLETIN, but a great number of items on particular dis-eases
and conditions in our state.
I move now to the Division of Dental Health. Let me say, as preamble, that
in a presentation before the Advisory Budget Commission one year, I discovered
that were the dental health as it ought to be for North Carolina children,
those in the first six grades would be expected to have some 17,000,000 teeth
altogether.
Think of the opportunity in the field of dentistry. Think of the number of
dentists we have and, like all health professionals, how many more we need.
But they work desperately to correct, to cure and to prevent. And I'll have
something to say later about prevention. Not only in the personal office pre-vention
sense of the word but, as you know, at the State Board of Health we
have a reasonably large staff of dentists who function with the schools in pre-vention
programs and illustrate some curative aspects. Here too we have
expanded so that we now have an internship in public health in dentistry. An
increasing number of dentists are turning to public health as a career and
their importance is being recognized.
42 FORTY-FIRST BIENNIAL REPORT
Last year for the first time we had a Federal appropriation specifically
geared to dental needs. We have had interest in oral cancer and through these
programs and with the cooperation of the practicing dentists five cases of oral
cancer were discovered in 1964 and fifteen in 1965.
And finally of great interest to us all, the dentists together with the engi-neers
and other North Carolinians have combined to push the use of fluoride
in the water whenever this is possible. Every effort is put forth to enhance
and increase the number of communities using it. There are now some 84
towns which fluoridate their public water supply. These cover a population
of about 1.4 million and we can now state that 31% of the population is cov-ered
by fluoridated water supplies.
I could go on, but in the interest of time let me turn to a third of our
seven divisions, Epidemiology.
Now the term Epidemiology is a broad one and has to do with events among
the people and quite clearly all of man's endeavors would fit into this. At the
State Board of Health the Division of Epidemiology performs many of the
functions filled by Divisions in other states which are labeled Divisions of
Preventive Services.
The Division of Epidemiology works in Communicable Disease, in Occupa-tional
Health, in Radiation Protection, Tuberculosis, and Venereal Disease.
It records the births and the deaths, the marriages and divorces. And it is
interested in Accident Prevention.
But among the things that were looked into this past year were the matters
of a large epizootic of Eastern encephalitis; a follow-up program of all birth
certificates to insure the fact that North Carolinians be adequately immunized
against those diseases for which childhood prevention is possible.
We looked also into a follow-up of the smallpox vaccinations to see what
kinds of reactions we were getting. At the State Fair this past year, in cooper-ation
with the Medical Society, a booth was maintained for the tetanus im-munization
of those who would stop by. A great many were immunized and
this proved to be a successful project.
There is more to be said. As you know, there is an epidemic of syphilis
nationally, but this has been controlled and halted in North Carolina. And
further than that, venereal disease control and instructions have been given in
a number of school systems. We have modernized, so to speak,—modernized
is perhaps not the word—but we have put in a new Tuberculosis Program
in line with national suggestions.
Because of wide spread increase in drownings in the state, the State Board
of Health is concerned. We lose too many from drowning, often in multiples.
There were a number of drownings in the past year in which four died simul-taneously.
We followed these up along epidemiological lines.
Of course we worked closely with the education system, whether this be
at the elementary school level, the high school or the college level, in imple-menting
our programs with them.
NORTH CAROLINA BOARD OF HEALTH 43
All of the birth certificates prior to 1945 have been microfilmed and, last
year to add to our armamentarium, we had 97,000 births, 42,000 deaths, 40,000
marriages and 11,000 divorces.
I might inject a note here; the common statistical data which says that
one out of every four marriages is dissolved by divorce would appear to be
borne out by a casual glance at our data with 40,000 marriages and 11,000
divorces. Let me say, however, that this is a false statistical base, it is not the
40,000 who married one year out of which 11,000 are divorced.
The 11,000 that were divorced come out of all of North Carolina's marriages
accumulated as of that time and the fracture rate there for marriage is far
lower than the one previously given as one in four.
Let me say a word about the Laboratory, a large organization, a four story
building, processing more than 650,000 specimens a year. Highlighted should
be the fact that, in cooperation with Personal Health, a new program to follow
up the possible occurrence of phenylketomuria was begun. This proved to be a
highly successful program. You know that in the management of this metabolic
defect if this can be discovered early enough, important destructive effects
can be prevented. Further than that, there is a great saving of personal and
public money which would be needed to maintain those who become mentally
defective if not adequately treated in time.
Because of interest around air pollution, water and occupational health
chemistries, the role of our chemistry program also increased. Again this year,
the amount of cancer cytology, especially cervical cytology, became more
important.
The infectious diseases, all of which have been with us since man began,
had more precise techniques applied. Advance was made in the management
of streptococcal diseases and syphilis.
I cannot speak without saying some words about our Local Health Divi-sion,
the Division of which Dr. W. Burns Jones had been Director until he
came into the role of Acting Assistant State Health Director, a very important
role in the State. Dr. Norton will succeed him in the changes that have taken
place.
In North Carolina we have had for nearly twenty years a Local Health De-partment
for each of our counties. Some of these, of course, are combined in
neighboring counties for the sake of efficiency, with a good Health Director
serving several counties. But here too the role is one of increase in service.
We do have, unfortunately, a considerable number of vacancies. In this area
there are too few people in the health profession, a shortage felt world-wide
and felt therefore among our health directors. We wish there were more health
directors available. We look for expanding their efforts.
In cooperation with the Economic Opportunity Act, we have been educating
people in the health education field. We have done a great deal of education
within the nursing groups through self-teaching systems by correspondence.
Then too, we have for emergency purposes stored in the State some fifty
disaster packaged hospitals, so that should a huge emergency occur these
44 FORTY-FIRST BIENNIAL REPORT
can be unpackaged and used. These are 200 bed hospitals and are prepositloned
around the state for disaster purposes. Fortunately we've not had to use them.
We have helped to sponsor a course in medical self-help so should there
be a great disaster those who are not close to medical care could assist with
help and carry on, we hope, through systems of self-care.
We have been working in the field of migrant health, important in North
Carolina. Not only do we take from the migrant stream, but we add to it.
Many crop harvests are dependent in part upon these migrant workers.
Through increased sanitation and working in this area we have made definite
improvements.
I come now to the Division of Personal Health, of which Dr. Jim Donnelly, a
member of the Society, is Director. There are programs in crippled children.
In correction of defects, the School Health Coordinating Service which is done
between our organization and the Department of Public Instruction.
While more might be said, perhaps at this point a word would be timely
about our relationship to Medicare. This will be a program at the Federal level
and concerns those of us in the State who relate to it.
In size the Medicare program is difficult to project. There are more than
367,000 North Carolinians who will be eligible for this by virtue of the fact
that they will be 65 or over when it begins. In addition to that, all of the health
personnel will be affected as will the institutions with which they associate.
This is not to mention the fiscal intermediaries, Pilot Insurance for Part B
and the Blue Cross Family for Part A. This will touch the lives of all of us,
our families, our elders and our institutions.
Excellent progress is being made in our North Carolina program. We are
told that we are as far along in this as the guidelines will permit, and we are
already off to a good and running start, though always one would wish to be
farther along. We are off to a good running start because we have a good
agency licensing hospitals in this' state. We have a high proportion of hos-pital
beds already accredited by the Joint Commission on Hospital Accredita-tion.
These will virtually automatically be certified.
The three C's in which we work are Certification of Institutions, Consulta-tion
with them as they wish or ask for aid in how to proceed should they wish
to participate, and, finally. Coordination. For these institutions will need agree-ments
with each other, ordinarily only one with another, so patients may be
efficiently transferred from hospital to extended care facilities, to home care
programs.
I had opportunity to discuss this at length at the first general session on
Monday, but let me add as a final word, that we are told that we are as far
along as can be at this time. Your State Board of Health is dedicated to
having this, as is the Society, the best Medicare program in the United States.
We have had superb cooperation, and I use the word advisedly, between
our policy making Board of which Dr. Baker is President, and other members
are in the audience, and the State Medical Society, the N. C. Hospital Associa-tion
and such others as have direct relationship with the Blue Cross people.
NORTH CAROLINA BOARD OF HEALTH 45
I continue with a few closing remarks.
The last of our seven Divisions is the Sanitary Engineering Division.
It has been said, and I believe wisely, that more freedom from Communic-able
Disease has been bought and brought to us by sanitary measures than
by any other. Whenever we increase our cleanliness, our education, improve
our housing, improve all of those things in the broad scope of human welfare
and when we begin to think of sanitation we improve man's lot. Sanitation
increases his life, increases his freedom from disease and increases his use-fulness.
For that reason, among the oldest public health measures are those
designed to improve the environment around us. In these days you know that
includes not only cleaning it up in the microbiological sense of the word and
making it free of disease but, in addition to that, the term sanitation already
includes and will include in the future, beautification of the environment as
well. Beautification is often no more expensive than any other system and
is sometimes cheaper.
The Sanitary Engineering Division, in long and vigorous action, looked
with great pains at many water supplies this past year, some 156 were added
to those already in existence. We now have a total of 887 water supplies under
supervision. As I noted earlier, 86 towns now have fluoridation of water.
We have looked at many restaurants, as you know when you travel through
North Carolina. You see in our restaurants the grading signs. Those of you
who have traveled considerably look first at grade signs for the large blue A,
because this tells you much about the institutions. You see it posted in hos-pital
lobbies, too, applying only to the kitchen, of course.
In many years of effort and in close cooperation with the restaurant in-dustry
the food service in North Carolina has been made a fine one.
In the matter of some of our specialized areas, for instance the matter of
shellfish, there we worked for a long time with those who are in charge. Now,
however, we have an arrangement between us, more legal and helpful than the
former one which had been in use for some forty years. Our present inspection
program is one in which we have manpower and in which we can apply
specialized abilities and have funds to carry it out. North Carolina is an im-portant
shellfish state.
We work with the growers and operators of Migrant Labor Camps. Those of
you who are familiar with them in years past know that persons oriented to
sanitation would quickly see much to be done. Here too we find that when
sanitation is improved the condition